Transanal vs. abdominal surgery for rectal cancers

Last Modified: March 7, 2004


Dear OncoLink "Ask The Experts,"
Is Transanal Endoscopic Microsurgery just as useful as the abdominal approach? I need to be sure that a cancerous polyp did not affect my blood vessels or lymph glands 


Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor, responds:

Operations for rectal cancers can use either the transanal or an abdominal approach. The decision is based on what stage the tumor is felt to be. Early stage rectal cancers may be removed transanally because the risk of spread to local lymph nodes is small. In effect, the entire tumor is removed without getting into the surrounding tissues. If the tumor is deeper or if there is evidence that the tumor is more aggressive or has invaded lymphatic or blood vessels, the risk for localized spread is higher. In these situations, a transabdominal approach is usually preferred in order to evaluate the tumor and the surrounding tissues, especially the lymph nodes. Assuming that there is no other spread to far organs like the liver, finding the tumor in the lymph nodes raises the stage of the tumor and usually leads to the recommendation of chemotherapy and/or radiation therapy. It all boils down to assessing the risk for a more advanced tumor with a higher risk for recurrence versus the risk of the two operations. Again, if there is any evidence that this is not just a very superficial early stage cancer, I usually recommend the more extensive surgical approach.

I hope this answers your question and helps you.