Long-term results of local excision for T1 rectal carcinoma: the experience of two colorectal units

Lebedyev, Alexander; Tulchinsky, Hagit; Rabau, Micha; Klausner, Joseph M.; Krausz, Michael M.; Duek, Simon D.

doi:10.1007/s10151-009-0521-3

Cited by 22 publications

(14 citation statements)

References 27 publications

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“…Additional risks communicated to patients include anal incontinence, rectal stenosis and rectovaginal fistula and no patients in this study experienced these complications. Overall, our complication rate was 8.5% which is significantly lower than the 50% reported with radical surgery and comparable with previous reports for TEM in the literature (5–21%) .…”

Section: Discussionsupporting

confidence: 90%

Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience

et al. 2019

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AimOrgan‐preserving local excision by transanal endoscopic microsurgery (TEM) for early rectal cancer offers significantly lower morbidity as compared to formal rectal cancer resection with acceptable outcomes. This study presents our 6‐year experience of TEM for rectal lesions referred to a specialist early rectal cancer centre in the UK.MethodData were collected for all patients referred for TEM of suspected early rectal cancer to a regional specialist early rectal cancer multidisciplinary team (MDT) over a 6‐year period.ResultsOne hundred and forty‐one patients who underwent full‐thickness TEM for suspected or confirmed early rectal cancer were included. Thirty patients were referred for TEM following incomplete endoscopic polypectomy. Final pathology was benign in 77 (54.6%) cases and malignant in 64 (45.4%). Of the 61 confirmed adenocarcinomas, TEM resections were pT0 in 17 (27.9%), pT1 in 32 (51.7%), pT2 in 11 (18.0%) and pT3 in 1 (1.6%). Thirty‐eight of 61 patients (62.3%) had one or more poor histological prognostic features and these patients were offered further treatment. Twenty‐three of 61 (37.7%) patients with rectal adenocarcinoma required no further treatment following TEM. Forty‐three cases of rectal adenocarcinoma were available for establishing recurrence rates. Two of 43 patients (4.7%) developed a recurrence at a median follow‐up of 28.7 months (12.1–66.5 months). The overall estimated 5‐year overall survival rate was 87.9% and the disease‐free survival rate was 82.9%.ConclusionAcceptable outcomes are possible for TEM surgery with appropriate patient selection, effective technique, expert histopathology, appropriate referral for adjuvant treatment and meticulous follow‐up. This can be achieved through an early rectal cancer MDT in a dedicated specialist regional centre.

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Section: Discussionsupporting

confidence: 90%

Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience

et al. 2019

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“…In particular, a precise evaluation of the depth of tumor invasion and lymph node metastasis is crucial for the appropriate selection of the patient. Even if EUS appears to be the most accurate preoperative diagnostic tool for investigating tumor invasion of the rectal wall, we could ascertain, as already indicated by others [28][29][30][31][32], a consistent discrepancy between preoperative EUS and histology staging of the tumors, with 27/78 (34.6%) understaged and 9/78 (11.5%) overstaged lesions. The high incidence of lesions that were considered benign at preoperative biopsies but were shown to be malignant after excision led us not to take into consideration the preoperative histology when benign.…”

Section: Discussionmentioning

confidence: 55%

Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm

et al. 2011

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BackgroundIndications and results of local excision of rectal lesions are currently under debate. Transanal endoscopic microsurgery (TEM), allowing a precise, full-thickness excision, could improve oncological results in early rectal tumors. Methods A prospective database was analyzed with the intent to identify risk factors for recurrence after TEM. Results Among 355 patients subjected to TEM, 107 had an adenocarcinoma: 48 pT1, 43 pT2, and 16 pT3. Comparing pre-and postoperative data, histological discrepancy was 20% and staging discrepancy was 34%. Mortality was nil, morbidity was 9%. Mean follow-up was 54.2 months (range = 12-164), follow-up rate was 100%. The 5-year disease-free survival rate was 85.9, 78.4, and 49.4% for pT1, pT2, and pT3, respectively (p = 0.006). Recurrence rate was 0% (0/26) in pT1sm1 cancers and 22.7% (5/22) in sm2-3 (p < 0.05). A submucosal infiltration represented a significant risk factor for recurrences: 0% sm1, 16.7% sm2, and 30% sm3. Recurrence in pT2 was 0% in patients who had neoadjuvant therapy and 26% in the others. At univariate analysis, diameter, sm stage, pT stage, tumor grading, margin infiltration, and lymphovascular invasion demonstrated statistical significance. Multivariate analysis indicated sm stage, pT stage, and tumor grading as independent predictors of recurrence. Conclusions TEM represents an effective curative treatment for pT1 sm1 rectal malignancies. pT1 sm2-3 patients should be considered high-risk cases if treated only by TEM. A consistent improvement in the preoperative assessment of the risk factors identified by the present study will be a crucial development for optimal treatment of early rectal cancers. Keywords Transanal endoscopic microsurgery Malignant rectal neoplasm Recurrence Risk factors The goal of oncological surgery is to achieve the best cancer control with preservation of function and quality of life. In the field of malignant rectal neoplasms, radical resection, consisting of anterior resection with total mesorectal excision (TME) when feasible and abdominoperineal resection (APR) when mandatory, represents the best curative treatment. Nevertheless, these procedures are burdened with a consistent morbidity rate, including genitourinary and sexual dysfunction (30-40%) [1][2][3][4], anastomotic leakage (5-17%) [5], and long-term functional bowel disturbance [6]. Up to 40% of patients experience perineal wound complications and long-term discomfort following APR, while stoma and stoma appliance-related complications occur in up to 66%. There is also significant psychological morbidity associated with change in body image and depression in 30% [7].A transanal approach to rectal malignant neoplasms, if suitable, would lower risks and improve functional results. Unfortunately, the conventional transanal excision is characterized by a high incidence of remnant disease or early recurrence [8,9]. For more than 25 years, transanal endoscopic microsurgery (TEM) had revolutionized the technique and outcome of transanal surgery, becoming the ...

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“…From an oncological perspective, there may be no benefit in performing radical surgery on tumours that have shown a pCR. In addition, there may be no oncological logic in performing radical surgery on a tumour that has been downstaged to pathological (p) T1 N0, as local excision would be a feasible alternative to radical surgery in a patient who presented initially with a tumour of this stage7, 8.…”

Section: Introductionmentioning

confidence: 99%

Rectum-conserving surgery in the era of chemoradiotherapy

Smith

Waldron

Winter

2010

British Journal of Surgery

137

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Long-term results of local excision for T1 rectal carcinoma: the experience of two colorectal units

Abstract: Local excision of early rectal cancer is a feasible and acceptable alternative to radical resection. It has low complication and recurrence rates and a short postoperative hospital stay.

Cited by 22 publications

References 27 publications

Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience

Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience

Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm

Rectum-conserving surgery in the era of chemoradiotherapy

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