TEM Surgery

Non-cancerous tumours of the rectum are a common condition that should be surgically removed as a gradual increase in size carries a risk of developing cancer. Apart from this risk, these tumours can cause rectal bleeding, tenesmus (continual desire to defecate) and mucous discharge. Small growths can be destroyed by "hot" diathermy biopsy, whereas slightly larger ones with a stalk can be cut away using a snare.

These tecniques though cannot be used with larger tumours due to a high risk of severe bleeding. TEM has become the method of choice for treating these. It is a minimally invasive technique that reduces the risks and side effects of major rectal surgery. It can be performed as a short stay procedure even without general anaesthetic, with minimal complications. In cases of cancerous tumours, TEMS is a preferred treatment as it can be repeated and, if not successful, allows further radical procedures.

The procedure is carried through the anus under anaesthesia using a 4cm diameter sigmoidoscope (type of telescope) connected to a light source and high resolution monitor. Once located, the tumour is removed using specialist forceps, diathermy (to seal blood vessels) and a suction device.

The incidence of complications during TEMS has been shown to be lower than that of major rectal surgery. Although infrequent, most cases of rectal tumours recurring after TEMS can be treated by a repeat procedure. If cancer is found in the specimen post-operatively, either major surgery or additional treatment with radiotherapy and/or chemotherapy is recommended.

Careful audit and research of TEM surgery is extremely important. The UK TEM User's Group started a National Database of TEM surgery in 1993 and this is now the largest database of TEM surgery in the World involving 21 centres. The results from this database have recently been published and provide invaluable guidelines for role of TEM surgery in rectal tumours, particularly early rectal cancer. This database has now been revised and extended to provide users with a simple and secure means of data collection and analysis. In addition, this system offers a management tool for patient care after TEM surgery and aims to assess the impact of this type of surgery on quality of life which will be vital in determining future role of TEM surgery.