Surgery For Rectal Cancer: Stages 0,I

A transanal resection is the removal of small tumors in the lower rectum near the anal opening which have not invaded the layers of the colon and which can be removed with a safety margin of healthy tissue around the tumors.

• When performed without a scope, the procedure is known as transanal excision (TAE). 
• When performed with a scope, the procedure is known as transanal endoscopic microsurgery (TAEM). 
• Both procedures leave the anus and sphincter intact. This allows patients to keep bowel function and eliminates the need for a permanent colostomy.
• A transanal resection is performed by a colorectal surgeon.  

Preparation For A Transanal Resection

Prep for a polypectomy starts the day before by cleaning out your rectum – just as you did when you prepared for either a colonoscopy or sigmoidoscopy. (If you haven't gone through a colonoscopy or sigmoidoscopy yet, click here to learn about the preparation.)  

Check to see if your mobile phone can record conversations. If not, get an inexpensive recorder. It will come in handy as noted below. The ability to record will also be useful for other doctor appointments. 

Line up someone to drive you home after the procedure.

For additional tips about preparing for an outpatient procedure, click here. 

NOTE: Before doing a transanal resection, you are likely to be given a test known as an endorectal ultrasound (ERUS). A ERUS shows whether the cancer has spread into adjacent tissues or lymph nodes. If there is a spread, full scale surgery will be used.

A Transanal Resection: The Procedure

• You will be led into the treatment room which usually has a table for you to lie on as well as the equipment that the doctor will need to use during the procedure.
• You will be put to sleep by a drug usually delivered by an i.v. in the arm.
• The procedure is performed through the anus without any skin cutting. 
• Polyps which are shaped like mushrooms may be removed with a wire snare which loops around the polyp. Electricity is then run through the wire to burn or destroy the tissue. This is known as electrocautery.  A grounding pad is placed on the body (usually the thigh) before the surgery to protect the patient. 
• Polyps with other shapes will be removed using other tools.
• A minimal amount of normal tissue (margin) is also removed.
• There are risks to the procedure, just as there are with any surgery. One of the risks is prolonged bleeding from the site. This generally resolves itself in time.

After A Transanal Resection

• After the procedure, you will wake up in a recovery room. After staying in the recovery area for about an hour, you will likely be moved to a room. Because this procedure generally involves general anesthesia and a lot of pain, you will likely be required to stay in the hospital for at least one night. To learn how to avoid error or infection in a hospital, click here. 
• Your doctor will discuss the results of the procedure. It is advisable to record this discussion or at least have someone with you who can remind you later of what was discussed. Your memory may not be normal for a while after recovering from the drugs. (Check your mobile phone to see if it records. If not, inexpensive recorders are readily available.)
• In addition to pain, you will likely have the same experience after leaving the doctor’s office that you had during the diagnostic procedure. The most common after effect is bloating and gas for a short period of time.
• While not common, additional risks from this surgery include:
  • Bleeding from the surgical site. This generally resolves itself in time.
  • Perforation of the colon or rectum which results in a hole in the wall. If this happens, the doctor is usually aware of the situation before you are discharged.
  • Your healthcare team will brief you about other possible complications to be aware of and what steps to take if they occur. 

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