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ANORECTAL CANCER :
LOCAL EXCISION AND
TEM
Kunsemedi Setyadi
Introduction
Introduction
I : 82%
Stage II : 76%
Stage III : 61%
Breast Ca
Radical mastectomy MRM
Lumpectomy & axillary dissection +
ER Lumpectomy + Sentinel Node
+ ER
Rectal Ca
Miles op Sphincter
preservation surgery ?
Full thickness local excision
ER
Freud :
Those surgeons are highly
conflicted, even
schizophrenic.... In their
approach to low T1 rectal
?
Minimal invasive
laparoscopy
Local excision
Sphincter preservation
TEM
Local procedures
Local excision /
Traditional Trans Anal
Excision (TAE)
Oncological efficacy
Recurrence rate
Preservation of anorectal &
genito-urinary function (quality of
life)
Morbidity/complication rate &
mortality
Longterm
survival
tal Mesorectal
Excision
(TME) remains the gold standa
TEM:
Transanal Endoscopic
Microsurgery development
Resection of colonoscopically
unresectable rectal adenomas
Selected rectal cancers
T1-2 rectal cancer
Palliative excision of T3
cancer
Resection of rectal & distal
sigmoid adenomas
Complex extra sphincteric
fistula (rectourethra/vaginal &
supralevator)
Anastomotic strictures
Contraindications
Insuflator/suction/irrigation/electrocautery
machine
Preoperative
preparations
Tumor localization :
Tumor
Pre op Staging
Resection option
-Mucosectomy
-Partial rectal wall
excision
-Full thickness excision
- Full thickness excision
with perirectal fat
Consent
Incontinence, bleeding
etc (Complications)
Formal celiotomy &
resection colostomy
Risk of incomplete
removal / inaccessibility
Sphincter dilation
Complications
Intraperitoneal
sepsis/peritoneal entry
Rectovaginal fistula
Suture line disruption /
anastomotic dehiscence 15%
Hemorrhage
Fecal incontinence, usually
transient 5%
Rectal stenosis
Conversion to laparotomy 2,6%
Urinary retention (temporary),
Semarang experience
Resection
T1
T2
T1
T2
51
22
17
83
4
96
19
80
0
94
9.4
83
6.7 3.2
7.5 4
2.3 0.95
3.78 1.5
Complications (%)
48
46 low risk
34 low risk
Recurrence
2 (4%)
2 (6%)
79
81
2.5 1.5
2.9 1.6
Complications
1 (2%)
5 (15%), 2 deaths
20
18
Recurrence
2 (10%)
None
100
96
Summary
Future direction
Rectal prolapse
Rectovaginal fistula /
extrasphincteric fistula in ano
Anastomotic stricture
Extended application for Cancer
NOTES portal
Thank you