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Serra-Aracil et al. Mini-invasive Surg 2019;3:37 I http://dx.doi.org/10.20517/2574-1225.2019.36 Page 5 of 11

Figure 1. Flow chart of the study patients. TEM: transanal endoscopic microsurgery; TEO: transanal endoscopic operation

Table 2. Descriptive epidemiological and preoperative data of patients who underwent TEM
Overall patients
Variables n = 716 (%)
Epidemiology Age (years) (median-IQR-range) 71 (IQR 16) (range 31-92)
Sex (%) Male 430 (60%)
Female 286 (40%)
Tumor size (cm) (median-IQR-range) 4 (IQR 2) (range 0.5-12)
Preoperative chemo-radiotherapy 44 (6.1%)
Re-TEM 24 (3.4%)
TEM after polypectomy with positive margin resection 48 (6.8%)
Distance from anal verge (cm) (median-IQR-range) 7 (IQR 5) (range 1-22)
Distance from tumor proximal margin to anal verge (cm) (median-IQR-range) 11 (IQR 4.5) (range 1-26)
Location of the tumor (%) Anterior 185 (25.8%)
Lateral 318 (44.4%)
Posterior 213 (29.7%)
Morphology of the lesion (%) Flat 169 (23.6)
Pedunculated 150 (21.3%)
Sessile 329 (47.1%)
Ulcerated 54 (7.6%)
ASA (%) I 23 (3.2%)
II 381 (53.2%)
III 254 (35.5%)
IV 58 (8.1%)

TEM: transanal endoscopic surgery; ASA: American Society of Anesthesiology scale; IQR: Interquartile range; Re-TEM: recurrence-TEM

grade I. Clinically relevant morbidity (Cl-D ≥ II) was reported in 36 (5%) patients with a Comprehensive
[12]
Complication Index (CCI) of 0. Fifty-nine (8.2%) patients presented asymptomatic postoperative fever.
The causes of death in the two (0.3%) patients who were exituswere reported in our previous publication .
[6]
The most frequent pathology was adenoma in 422 (58.9%) patients. Full wall resection was achieved in 710
(99.2%) patients and only 61 (8.6%) patients presented positive margins.

Table 4 displays the most frequent types of complications related to TEM. In 139/158 (88%) patients, the
complications were surgical. The most frequent complication was rectal bleeding in 115/716 (16.1%) patients;
however, the bleeding was Cl-D grade I in 85/115 (73.9%) patients. Fifteen of 115 (13%) patients required
surgical treatment (a new TEM in all cases). Rectal bleeding was a clinically relevant complication (Cl-D ≥
II) in 25/716 (3.5%) patients.