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No external incisions for early stage rectal cancer

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“Virtua is one of just a few centers in the region that offers a highly select population of early stage rectal cancer patients a surgical option that greatly reduces the morbidity of open abdominal surgery. It’s called transanal endoscopic microsurgery (TEM),” says David Schaffzin, MD, a Fox Chase Virtua Health Cancer Program colorectal surgeon.

TEM is performed through the anus with specially designed equipment and requires no external incisions. It is the only FDA-approved procedure that falls under the aegis of natural orifice transluminal endoscopic surgery. Importantly, TEM has demonstrated comparable five-year survival rates for early stage rectal cancer as compared with open surgery.

“The procedure is appropriate for individuals with a rectal cancer of T1 or less, with no lymph node involvement and a well to moderately differentiated histology,” explains Edwin Empaynado, MD, Virtua colorectal surgeon.

All lesions should be staged by an endorectal ultrasound to determine if the TEM procedure is appropriate. A pre-operative biopsy may not alone indicate the depth of the lesion or lymph node involvement.

Prior to TEM, even patients with a large adenoma high in the rectum, had to undergo an open abdominal procedure with the potential accompanying morbidity of bladder or erectile dysfunction or colostomy, as well as post-operative functional bowel problems.

“The benefit of TEM,” explains Stephen Pilipshen, MD, chair of surgery, director of surgical services at Virtua Memorial, and a Fox Chase Virtua Health Cancer Program colorectal surgeon, is that "unlike traditional colonoscopy equipment that removes a large rectal polyp piecemeal with close surgical margins, with TEM, I can excise a full thickness of a surgically intact lesion. This allows the pathologist to clearly describe the margins and make a firm diagnosis.”