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Transanal endoscopic microsurgery (TEM) is a surgical local excision technique for early stage rectal cancer. The main indication is represented by cT1N0 G1-2 rectal tumors with a maximum diameter of 3 cm, involving less than 30% of the rectal circumference, but it can be considered in case of T1-T3 lesions in high risk patients or in patients rejecting radical surgery.
TEM is performed through dedicated instruments including a rigid rectoscope and angled instruments. Standard laparoscopic scope, camera and insufflator can be used. Technical principles include full-thickness excision of the tumor with at least 10 mm normal circumferential margin and 2 mm deep margin into the perirectal fact. After specimen extraction closure can be achieved using a running suture. Possible complications with this procedure could be intraoperative or postoperative bleeding, peritoneal perforation, urinary complications, infectious complications and stenosis. Adequate excision is defined by a T1 sm1, G1-2, rectal cancer without lymphovascular or perineural infiltration, without infiltration of the resection margin and no high tumor budding. In case of adverse histopathological adverse features, rectal resection with total mesorectal excision should be carried out.