Transanal endoscopic microsurgery for rectal cancer. Long-term oncologic results

Abstract

Our data support that transanal endoscopic microsurgery is an adequate treatment for T1 low-risk tumor, and no additional measures are required. For T2 low-risk lesions, our study showed a higher local recurrence rate than that reported after radical surgery but a similar survival outcome.

Transanal Endoscopic Microsurgery with or without Completion Total Mesorectal Excision for T2 and T3 Rectal Carcinoma

“…In those cases, where completion TME is not performed, TEM-only is regarded as a palliative treatment option. In contrast to patients treated with curative intent, where literature is extensive [14-19], to our knowledge no literature exists on the course of disease following TEM for pT2 or more invasive rectal carcinomas without (neo-)adjuvant (chemo)radiotherapy in comparison to completion TME. This study presents the oncologic outcomes and short-term morbidity of patients with pT2 or more invasive rectal carcinomas, treated with TEM-only, and outcomes were compared in patients who did undergo completion TME.…”

Rectal Carcinoma: Multi-Modality Approach in Curative Local Treatment of Early Rectal Carcinoma

“…A submucosal infiltration represented a significant risk factor for recurrences: 0% sm1, 16.7% sm2, and 30% sm3. Another prospective study (Ramirez et al, 2011) also supports transanal endoscopic microsurgery as an adequate treatment for T1 low-risk tumour and no additional measures are required. The five-year overall survival was 94% and cancer-specific survival was 96%.…”

“…TEM remains the treatment of choice for stage T1 low risk rectal carcinomas. Patient with pT1 sm2-3 and T2 low risk lesions should be considered high-risk cases if treated only by TEM (Morino et al, 2011;Ramirez et al, 2011).…”

Transanal endoscopic surgery: patient selection and perspectives

“…These patients can undergo adjuvant radiation therapy to the rectum with the goal of eradicating any residual disease or any possible positive lymph nodes in the mesorectum, resulting in less morbidity and improved functional outcomes. Ramirez et al 71 looked at patients with "high-risk" T1 and "low-risk" T2 tumors who received radiotherapy following excision and found higher local recurrence rates when compared to radical surgery. However, survival outcomes were similar with a 5-year cancer-specific survival rate of 93% in the postoperative radiotherapy group.…”

“…However, survival outcomes were similar with a 5-year cancer-specific survival rate of 93% in the postoperative radiotherapy group. 71 Nevertheless, it is important to discuss other alternative treatments with patients since this is not the standard of care and patients must understand the risk of recurrence.…”