A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer

Abstract

Patient selection for TEM is frequently governed by fitness for radical surgery rather than suitable tumour biology. TEM can produce long-term outcomes similar to those published for radical total mesorectal excision surgery if applied to a select group of biologically favourable tumours. Conversion to radical surgery based on adverse TEM histopathology appears safe for p T1 and p T2 lesions.

S3-Leitlinie – Kolorektales Karzinom

“…Stellt sich erst nach transanaler Vollwandresektion eine Hoch-Risiko-Konstellation heraus, so ist die sekundäre radikale Nachoperation innerhalb eines Monats nicht mit einer Verschlechterung der Prognose im Vergleich zum primär radikalen Vorgehen assoziiert [772,776]. Lehnt der Patient in dieser Situation eine radikale Nachoperation ab, so kann eine adjuvante Radiochemotherapie erwogen werden.…”

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

“…LE has also been proposed in frail patients or in those refusing major surgery to remove more invasive rectal cancers (T1 sm2-3 and T2). However, the risk of recurrence is significantly higher, and therefore LE alone should be considered only as a compromise procedure [89][90][91][92]. The use of neoadjuvant (chemo)radiation therapy followed by full thickness LE of more advanced T1 and T2…”

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

“…On the other hand, the published results on the oncological outcome following TEM remain controversial, since other studies [85] reported favorable results with local recurrence rates lower than 10%, others [86] confirmed the lower local recurrence rates following TEM compared to the transanal local excision (18.5% vs 27.7%) but without statistical significance, others [87] stated alarming figures for local recurrence following TEM for T1 rectal tumors, while local recurrence rates as high as 20.5% have also been reported [88] . In an attempt to evaluate further the above findings, both Tytherleigh et al [89] in 2008, as-well-as Bach et al [90] in 2009, offered possible explanations for these unfavorable results. Both studies made clear that the depth of submucosal invasion (sm level) constituted a strong predictor for recurrence, since sm1 tumors showed low recurrence rates, but sm2-3 tumors showed recurrence rates similar to the T2 lesions [89,90] .…”

“…In an attempt to evaluate further the above findings, both Tytherleigh et al [89] in 2008, as-well-as Bach et al [90] in 2009, offered possible explanations for these unfavorable results. Both studies made clear that the depth of submucosal invasion (sm level) constituted a strong predictor for recurrence, since sm1 tumors showed low recurrence rates, but sm2-3 tumors showed recurrence rates similar to the T2 lesions [89,90] . Thus, locally excised pT1sm1 tumors without lymphovascular invasion, up to 3 cm in diameter, have a local recurrence rate of less than 5%, while locally excised pT1sm2-3 tumors have a local recurrence rate of up to 20%, similarly to T2 tumors [72] .…”