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Hépato-Gastro & Oncologie Digestive

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Chirurgie transanale : pour qui et comment ? Volume 18, issue 2, Mars-Avril 2011

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Authors
Hôpital Beaujon, pôle des maladies de l’appareil digestif (PMAD), service de chirurgie colorectale, 100, boulevard du Général-Leclerc, 92118 Clichy cedex, France

Radical rectal resection is the usual operation for rectal tumors, especially for malignant lesions. Transanal local surgery is an alternative for benign rectal tumors with excellent operative results (no mortality, post operative morbidity < 10%) and no risk of functional troubles or genito-urinary dysfunction. Transanal endoscopic microsurgery (TEM) allows locally complete excision of rectal tumors with high surgical excision quality, especially for mid and upper rectal lesions, which are inaccessible by conventional local surgery. For cancer, local surgery is recommended for T1sm1 lesions and requires further radical surgery in case of unfavorable pathologic criteria. Local surgery could be proposed in patients with advanced locally tumors with downstaging following radiochemotherapy but this strategy requires further studies.