Authors' objectives:

This report addresses the safety, effectiveness and cost-effectiveness of transanal endoscopic microsurgery (TEM), a minimally invasive surgical technique, which is performed endoluminally and is optically enhanced (usually through stereoscopic vision). It is primarily used for the removal of certain lower and upper rectal tumours.

Authors' results and conclusions: Adenomas Safety: In one randomised controlled trial (RCT) detailing treatment of adenomas, no difference in the rate of early complications could be detected between TEM (10.3%) and direct local excision (LE) (17%) procedures (relative risk (RR) 0.61, 95 per cent confidence interval (CI) 0.29 to 1.29). The low complication rate was consistent with the results from case series of TEM for treating adenomas (generally under 10%). Mortality after TEM was low, with no perioperative deaths reported. Effectiveness: On the basis of one RCT, TEM appears to result in less local recurrence (6/98; 6%) than direct LE (20/90; 22%) (RR 0.28, 95% CI 0.12 to 0.66). The 6 per cent rate of local recurrence for TEM in this trial is consistent with the rates found in TEM case series (5% median). Carcinomas Safety: As for adenomas, no difference could be detected in the rate of complications between TEM and direct LE methods for carcinomas (RR for overall early complication rates 0.56, 95% CI 0.22 to 1.42). No perioperative deaths were reported in the RCT. In one nonrandomised study, there were significantly fewer complications with TEM compared to radical resection, for a subgroup of patients with low-risk carcinomas (P = 0.04). Effectiveness: No differences in survival or local recurrence rate between TEM and AR could be detected in either the RCT (hazard ratio of 1.02 for survival) or the nonrandomised comparative study. There were 2/25 (8%) TEM recurrences in the RCT, but no figures were given for recurrence after AR. In 31 case series, the median local recurrence rate for TEM was 8.7 per cent, ranging from 0 per cent to 50 per cent.

Authors' recommendations: MSAC recommends, on the strength of evidence pertaining to transanal endoscopic microsurgery, that public funding should be supported for this procedure.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.msac.gov.au/reports.htm

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Medical Services Advisory Committee

Contact Address: MSAC (MDP 107), GPO Box 9848, Canberra, ACT 2601, Australia. Tel: +61 2 6289 6811; Fax: +61 2 6289 8799.

Contact Name: msac.secretariat@health.gov.au

Contact Email: msac.secretariat@health.gov.au

Copyright: Medical Services Advisory Committee (MSAC)