Endoscopic posterior mesorectal resection as an option to combine local treatment of early stage rectal cancer with partial mesorectal lymphadenectomy

Abstract

The technique of "Endoscopic posterior mesorectal resection" represents an interesting option in the surgical treatment of rectal cancer, as it allows for the first time an organ preserving resection of local lymph nodes in the small pelvis. It may evolve as an efficient new staging procedure to identify patients with metastatic disease who may benefit from multimodal treatment or extended surgery.

Transanal endoscopic microsurgery combined with endoscopic posterior mesorectum resection in the treatment of patients with T1 rectal cancer - 3-year results.

“…Koeninger et al . also observed no intraor postoperative complications in a report on 2 patients treated using the EPMR technique [15]. Similarly, in the 3-year follow-up mortality was also zero in our study group and we had 1 case of intraoperative perforation, treated endoscopically with two additional sutures, which led to an uneventful postoperative course.…”

“…Koeninger et al . also did not report any postoperative complications, in the sense of deterioration of continence control [15]. Of course we are aware of a limitation of this study.…”

“…histopathological workup revealed only one tumor-free LN in the first resected specimen. However, in the second case they found metastatic involvement in one out of six excised LN [15]. In the study by Wu et al ., assessing local recurrence rates of patients with high risk T1 rectal cancer (RC) after TEM, 15.4% of patients had mesorectal LN involvement (T1 RC patient reoperated after TEM within 4 weeks with unfavorable histopathological factors) [16].…”

Laparoscopic radioisotope-guided sentinel lymph node mapping and excision of the rectum—an experimental study

“…This access could be limited to radioguided SLN detection and excision. The benefit would be the ability to choose, if necessary adjuvant therapy or further surgery [23][24][25].…”

A modified sentinel lymph node technique combined with endoluminal loco‐regional resection for the treatment of rectal tumours: a 14‐year experience

“…Another loco‐regional nodal staging technique in patients with rectal cancer is posterior mesorectal resection (PMR) reported by Zerz et al . . After full‐thickness TEM excision of pT1 lesions, PMR is performed with minimally invasive retroperitoneal access.…”