New method offers option for colorectal surgery

Our Review Summary

Transanal endoscopic microsurgery (TEM) is a less invasive technique for removing cancer lesions and large polyps in the lower sigmoid colon and rectum. TEM offers potential advantages to the standard abdominal approach, such as a lack of an abdominal incision and faster recovery. However, to date there have been no large clinical trials comparing TEM to standard approaches.

The story clearly states that the availability of TEM is limited because few surgeons are trained to perform the surgery and that TEM has been around for a while but is only being recently used in the US. The story does not overstate the prevalence or seriousness of colon cancer or large polyps, thereby avoiding disease mongering. The story accurately points out that not even all of the large polyps are in fact cancer but that they will generally progress to cancer over time.

However, the story only quotes one expert. The story should have quoted multiple experts who could have provided some perspective. The story does not quantify the benefits of TEM, either in terms of safety or effectiveness. Nor does the story mention the costs of the procedure, which could be substantial.

The story mentions studies showing that TEM is effective, but there is no discussion of the strength of the available evidence, how these studies were performed and what questions remain about TEM. Most importantly, however, the story does not mention any harms of TEM, which makes it sound like the procedure has no drawbacks. While it is true that TEM is less invasive, there is still a risk of bleeding, perforation, and the need for repeat procedures.

In many cases with new procedures the risks of the procedure are not well known (either because the pioneers are exceptionally skilled, or because there have not been enough cases to detect rare harms).  When the new procedure is then adopted, we see a higher risk as less well-trained providers use it.

For that reason, it is absolutely critical to have studies showing its effectiveness and safety, but the article doesn’t emphasize that need for – and the current state of – the evidence.