Oncological outcomes of transanal local excision for high risk T₁rectal cancers

Abstract

AIM:To evaluate the oncological outcomes of transanal local excision and the need for immediate conventional reoperation in the treatment of patients with high risk T1 rectal cancers. METHODS:Twenty five high risk T1 rectal cancers treated by transanal local excision at the Guangdong General Hospital were analyzed retrospectively. Twelve patients received transanal local excision and 13 patients underwent subsequent immediate surgical rescue after transanal local excision within 4 wk. Differences in the local recurrence rates and 5-year overall survival rates between the two groups were analyzed. The prognostic value of immediate conventional reoperation for high risk T1 rectal cancers was also evaluated. RESULTS:The median follow-up period was 62 mo. The local recurrence rates after transanal local excision for high risk T1 rectal cancer were 50%. By immediate conventional reoperation, the local recurrence rates were significantly reduced to 7.7%. The difference between these two groups was statistically significant (P = 0.030). Kaplan-Meier survival analysis showed a trend for decreased 5-year overall survival rates for patients treated by transanal local excision compared with immediate conventional reoperation (63% vs 89%). CONCLUSION:Transanal local excision cannot be considered sufficient treatment for patients with high risk T1 rectal cancers. Immediate conventional reoperation should be performed if the pathology of the local excision is high risk.

Completion Total Mesorectal Excision After Transanal Local Excision of Early Rectal Cancer: A Systematic Review and Meta-analysis

“…Pooled rates were calculated using 15 studies 8,10,14,28–30,34,38,40–44,47,49 reporting recurrence outcomes. Two studies 33,45 were excluded, as reported data were not specific to the cTME cohort.…”

“…No significant difference was found between cTME and pTME resections for local (RR, 1.35; 95% CI, 0.70-2.61; p = 0.37), systemic (RR, 1.15; 95% CI, 0.50-2.66; p = 0.75), or all recurrence (RR, 1.13; 95% CI, 0.28-4.52; p = 0.86). Pooled rates were calculated using 15 studies 8,10,14,[28][29][30]34,38,[40][41][42][43][44]47,49 reporting recurrence outcomes. Two studies 33,45 were excluded, as reported data were not specific to the cTME cohort.…”

“…Fourteen studies reported a mean or median time interval from TAE to cTME with a weighted average of 6.8 weeks for 318 patients (range, 0-45 wk; Table 2). 8,10,11,30,31,34,35,[37][38][39]41,42,44,46 Four further studies reported a time cutoff of <4, 28,49 <12, 43 or <15 47 weeks. A subset analysis of any outcome by time interval was attempted but was not possible with the reported data.…”

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

“…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 ]. In our study group, the average number of harvested LN was also 6.9 (range: 4–11) with no case of metastases.…”

Selecting Patients With Locally Advanced Rectal Cancer for Neoadjuvant Treatment Strategies

“…In practice, transanal resection is usually only offered to those with T1 SM1/SM2 tumors that are well to moderately differentiated with no clinical or radiological evidence of lymphadenopathy [26]. Those with T1 SM3 or T2 tumors are at higher risk of local nodal involvement with subsequent higher rates of local recurrence when compared with traditional surgical approaches [27,28]. Accurate staging and patient selection are essential in this setting.…”