Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.1892
Peer-review started: April 5, 2023
First decision: June 14, 2023
Revised: June 24, 2023
Accepted: July 29, 2023
Article in press: July 29, 2023
Published online: September 27, 2023
Surgical treatment of rectal tumors in young patients should help patients achieve a good quality of life and, at the same time, be based on efficient oncologic excision. The transanal endoscopic microsurgery (TEM) technique enables high-quality excision of certain rectal lesions.
To explore the outcomes in young patients undergoing TEM for rectal lesions.
We set the age cut-off to 50 years due to the above mentioned minimal age for colonoscopy screening and the rare incidence of colorectal cancer before this age.
This is a retrospective cohort study on all patients under the age of 50 years who underwent TEM procedures at our medical center between January 2005 and December 2018. Patients were evaluated 2 wk following surgery and then at 3-mo intervals for the first two postoperative years, and every 6 mo from then on. Each follow-up visits also included a rigid rectoscopy. A descriptive data analysis was performed for the categorical variables, and the ranges and means were calculated for the continuous variables.
During the study period, 186 patients underwent TEM procedures. Of these, 26 patients (14%) were under the age of 50 years and therefore included in the study. The mean age was 43.3 years (range 21-49 years). Eleven (42%) of the patients were male. Indications for TEM were low-grade dysplasia adenomas in seven patients (27%), high-grade dysplasia adenomas in five (19.2%), carcinoma diagnosed in preoperative biopsies in four (15.4%), positive margins following endoscopic polypectomy in four (15.4%), and other pathologies (one tailgut cyst, two suspected carcinoid, and three undetermined pathologies) in six (23%). No major intraoperative or postoperative complications were documented. There was no residual tumor or lymph node metastasis in the AR specimens in either case. In the mean follow-up period of 55 mo (range 20-81 mo, median 80 mo), local recurrence of the rectal tumor was detected in one female patient 33 mo after TEM for T1 carcinoma. The patient underwent radiochemotherapy and laparoscopic abdominoperineal resection. The final pathology was T3, without the involvement of nodes. There were no reports of postoperative incontinence in any of the patients.
TEM of benign rectal lesions in young adult patients is safe and leads to excellent outcomes. For early rectal cancer in this group of patients, TEM may offer a balance between postoperative quality of life and the effectiveness of the oncologic resection; therefore, it may be considered in selected cases as an alternative to radical surgery in young adult patients.
The limitations of this study include its small sample size, retrospective nature, and various pathologies. There was also variability in perioperative care, as it evolved over the years due to long accrual periods. Furthermore, diagnostic modalities were not uniform for all patients, which may have impacted the choice of surgical approach and the various pathologies.