Purpose: Transanal endoscopic microsurgery (TEM) is a minimal invasive technique for the local resection of rectal tumors. Patients with colon cancer and rectal tumor could be treated with colectomy for colon cancer and TEM for rectal mass that avoid radical surgery. The purpose of this study was to evaluate the safety and feasibility of simultaneous TEM and colon resection for the patients with colon cancer and rectal mass.
Methods: Twelve patients with colon cancer and synchronous rectal mass were treated with TEM and colon resection simultaneously in Samsung Medical Center between April 1997 and January 2002. Average patients age was 58.2 (range 38.0 ~ 81.0) and there 7 men and 5 women. Study Parameters were locations and operation methods of colon cancer, distance from and verge of rectal mass, pathologic finding, operation time, complications and recurrence.
Results: The location of colon cancer were sigmoid colon (5 cases), ascending colon (3 cases), and one case in cecum, hepatic flexure, transverse colon, and descending respectively. The median distance of rectal mass from anal verge was 10 (range 2~ 17) cm and median size was 2.0 (range 0.7 ~ 3.0) cm. Operation for colon cancer were right hemicolectomy (6 case), anterior resection (5 cases), left hemicolectomy (1 case) and one of these operation was laparoscopic anterior resection. The median total operating time was 120 (range 100~ 335) min. and median operating time for TEM was 20 (range 15 ~ 45). There were two complications, one was intestinal obstruction and the other was wound infection in abdomen. There were no specific complication related to TEM. Pathologies of rectal mass were tubular adenoma (4 cases), tubular adenoma with low grade dysplasia (2 cases), tubular adenoma with high grade dysplasia (2 cases), adenocarcinoma with mucosa invasion (3 cases), lipoma (1 case), and hyperplastic polyp (1 case). Two patients complained diarrhea and constipation respectively but 10 patients preserved defecation function. In TNM stage of colon cancer, six cases were stage Ⅰ, one case was stage Ⅱ and four cases were stage Ⅲ. The median duration of follow up was 12.5 (range 0.6~49) month. One case was recurred in peritoneal cavity and lung at 35 month and died at 45 month after the operation.
Conclusion: In patients with colon cancer and rectal tumor, local therapy using TEM is feasible and safe procedure and sustains the quality of life without functional impairment.
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