Introduction An increased volume of colonoscopy has resulted in more polyps being detected, some of which contain early cancer. In the rectum, such polyps are often removed endoscopically and then found to have cancer with involved margins, posing a management dilemma. Transanal endomucosal MicroSurgery (TEMS) offers a method for scar resection to detect residual cancer whilst avoiding major surgery. The aims of this study were to determine the frequency of such cases, what proportion of them had residual cancer in the scar and if they did not, what proportion later recurred.
Method Our TEMS database was scrutinised for all ‘TEMS Excision of Scar’ cases. To confirm survival a case notes review was performed and all patients contacted by telephone. For deceased patients the general practice was contacted for cause of death. The data was analysed using SPSS.
Results 18 procedures were performed between January 2004 and January 2015. Twelve were male with a mean age of 72. Three patients were found to have residual cancer in their scar and were recommended further treatment. Of the 15 patients with no residual cancer there was one recurrence at 4 years (6.7%). This patient died one week following major resection. Seven times as many procedures were performed in 2014 compared to 2004.
Conclusion TEMS excision of scar appears to be a good discriminator for selecting patients who would benefit from conservative treatment following endoscopic polypectomy with cancer found at the diathermy edge. More cases and longer follow up is required to ensure TEMS excision of scar is a safe option for the future as the frequency of this clinical situation increases.
Disclosure of interest None Declared.
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