Modern management of T1 rectal cancer by transanal endoscopic microsurgery: a 10‐year single‐centre experience. (2nd July 2018)

• Record Type: Journal Article
• Authors: Jones, H. J. S.; Hompes, R.; Mortensen, N.; Cunningham, C.
• Is Part Of: Colorectal disease. Volume 20:Number 7(2018)
• Page Start: 586
• Page End: 592
• Publication Date: 2018-07-02
• Subjects: early rectal cancer -- local excision -- TEM -- local recurrence; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.14029
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: Minimally invasive, organ‐sparing surgery has been used increasingly for early rectal cancer in recent years. However, local recurrence remains a concern. This study presents a 10‐year single‐centre experience of recurrence after local excision for T1 rectal cancer. Method: Data were collected prospectively on all patients undergoing local excision by transanal endoscopic microsurgery (TEM) in a single institution. Data covering a 10‐year period were analysed. Results: In all, 192 patients underwent TEM for rectal cancer; 70 of these had T1 tumour in the TEM specimen and did not have preoperative radiotherapy. Four were managed with completion surgery following TEM and a further six had radiotherapy; 60 underwent surveillance alone. Local recurrence occurred in six patients; three underwent salvage surgery. Estimated local recurrence at 3 years was 7.2% for the surveillance alone group. Conclusions: Local recurrence rates were lower than previous studies. Better preoperative assessment, more effective local excision surgery and postoperative radiotherapy may be contributory factors to a better‐than‐predicted outcome. Local excision should be offered as part of standard of care for T1 rectal cancer in the presence of good preoperative selection and meticulous surveillance.