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Levic-Souzani et al. Mini-invasive Surg 2018;2:25 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.35

Review Open Access

Completion proctectomy following transanal
endoscopic microsurgery for early rectal cancer

Katarina Levic-Souzani , Orhan Bulut 1,2
1
1 Gastrounit-Surgical Division, Center for Surgical Research, Copenhagen University Hospital, Hvidovre 2650, Denmark.
2 Institute of Clinical Medicine, University of Copenhagen, Copenhagen 1165, Denmark.

Correspondence to: Dr. Orhan Bulut, Gastrounit-Surgical Division, Center for Surgical Research, Copenhagen University
Hospital, Hvidovre 2650, Denmark. E-mail: Orhan.Bulut@regionh.dk

How to cite this article: Levic-Souzani K, Bulut O. Completion proctectomy following transanal endoscopic microsurgery for
early rectal cancer. Mini-invasive Surg 2018;2:25. http://dx.doi.org/10.20517/2574-1225.2018.35

Received: 31 May 2018 First Decision: 23 Jul 2018 Revised: 2 Aug 2018 Accepted: 2 Aug 2018 Published: 16 Aug 2018
Science Editor: Gordon N. Buchanan Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Transanal endoscopic microsurgery (TEM) has proven to be a safe and effective procedure in removal of rectal lesions
and may be used in treatment of early rectal cancer in selected patients. In cases when the TEM specimen shows
non-radical resection, or histological high-risk factors, completion proctectomy (CP) is warranted. It is debated when
it is the best time to perform CP following TEM. It is furthermore uncertain whether CP leads to an increased risk
of abdominoperineal excision. Herein, we review the available literature regarding controversial issues with early
completion proctectomy following TEM.

Keywords: Transanal endoscopic microsurgery, total mesorectal excision, completion proctectomy, early rectal cancer

INTRODUCTION
[1]
Transanal endoscopic microsurgery (TEM) was first introduced in 1984 by Buess et al. as a minimally in-
vasive surgical technique for the resection of large rectal adenomas. With TEM technique, a full-thickness
en bloc excision is possible in the entire rectum, which may be technically difficult by other local proce-
dures such as transanal excision (TAE). TEM has proven to be a safe and effective procedure in removal of
[2-9]
rectal lesions . TEM has furthermore considerably lower morbidity and mortality compared with con-
ventional radical rectal resection for rectal tumors [10-15] . For patients with tumors in the lower part of the
rectum, local excision by TEM may offer a chance for preserved bowel continuity and avoidance of rectal
amputation with subsequent consequences.

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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