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Diagnosis and Endoscopic Management of Digestive Diseases pp 67–81Cite as

TEM and TAMIS for Large Rectal Neoplasm

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Abstract

Minimally invasive treatment of large rectal neoplasms by transanal endoscopic microsurgery (TEM) and, more recently, by transanal minimally invasive surgery (TAMIS) has become a common procedure. Since the introduction of TEM in 1983, indications have been widely extended, even if preoperative staging actually presents many limitations. TEM is nowadays a validated and standardised technique, allowing transanal resection of wide lesions with very low recurrences and complication rate. If compared to endoscopic procedures like endoscopic submucosal dissection (ESD), TEM seems to be able to warrant better oncologic results, with similar complication rate. TAMIS has been introduced in 2010 and still requires a strong validation. It is not yet clear if it really presents advantages in comparison to TEM, both from a technical and an economical point of view. The current indications to TEM/TAMIS are represented by benign lesions and early rectal cancers deepening no more than 1 mm in the submucosal layer. The goal of the research is the extension of TEM/TAMIS procedures to more advanced rectal cancers, in order to avoid the complications related to total mesorectal excision (TME). Preoperative neoadjuvant chemoradiotherapy and mesorectal lymph node mapping with sentinel node biopsy are two promising strategies with interesting preliminary results. Rectal-sparing surgery should be the goal in treating early rectal cancer but only if capable to warrant a radical and curative resection. A consistent improvement in rectal cancer staging will therefore allow a real tailored therapy, contributing to a significant reduction of invasiveness of the treatment.

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Authors and Affiliations

  1. General Surgery I, Department of Surgical Sciences, University of Torino, C.so Dogliotti 14, 10126, Torino, Italy

    Simone Arolfo & Alberto Arezzo

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  1. Simone Arolfo
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  2. Alberto Arezzo
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Correspondence to Alberto Arezzo .

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Editors and Affiliations

  1. S. Agostino Estense Hospital, Modena, Italy

    Rita Conigliaro

  2. S. Agostino Estense Hospital, Modena, Italy

    Marzio Frazzoni

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Arolfo, S., Arezzo, A. (2017). TEM and TAMIS for Large Rectal Neoplasm. In: Conigliaro, R., Frazzoni, M. (eds) Diagnosis and Endoscopic Management of Digestive Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-42358-6_4

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  • DOI: https://doi.org/10.1007/978-3-319-42358-6_4

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