Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses

PURPOSE: Transanal endoscopic microsurgery, developed by Buess in the 1980s, has become increasingly popular in recent years. No large studies have compared the effectiveness of transanal endoscopic microsurgery with traditional transanal excision. METHODS: Between 1990 and 2005, 171 patients underwent traditional transanal excision (n=89) or transanal endoscopic microsurgery (n=82) for rectal neoplasms. Medical records were reviewed to determine type of surgery, resection margins, specimen fragmentation, complications, recurrence, lesion type, stage, and size. RESULTS: The groups were similar with respect to age, sex, lesion type, stage, and size. Mean follow-up was 37 months. There was no difference in the complication rate between the groups (transanal endoscopic microsurgery 15 percent vs. traditional transanal excision 17 percent, P=0.69). Transanal endoscopic microsurgery was more likely to yield clear margins (90 vs. 71 percent, P=0.001) and a nonfragmented specimen (94 vs. 65 percent, P < 0.001) compared with transanal excision. Recurrence was less frequent after transanal endoscopic microsurgery than after traditional transanal excision (5 vs. 27 percent, P=0.004). CONCLUSIONS: Transanal endoscopic microsurgery is the technique of choice for local excision of rectal neoplasms.