Skip to main content

Advertisement

SpringerLink
Log in

Outcomes for early rectal cancer managed with transanal endoscopic microsurgery

A 5-year follow-up study

  • Original Articles
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

This study aimed to evaluate the long-term risk of local and distant recurrence as well as the survival of patients with early rectal cancer treated using transanal endoscopic microsurgery (TEM).

Methods

The study reviewed 69 patients with Tis/T1/T2 rectal cancer treated using full-thickness excision between 1991 and 1999. The pathology T-stages included 25 Tis, 23 T1, and 21 T2. The median follow-up period was 6.5 years (range 5–10.2 years).

Results

The overall local recurrence rate was 8.7%. The 5-year local recurrence rate was 8% for Tis, 8.6% for T1, and 9.5% for T2. All six patients with recurrence were managed surgically. The 5-year disease-specific survival rate was 100% for Tis, 100% for T1, and 70% for T2. The overall cancer-related mortality rate was 7.2%.

Conclusions

After local excision of early rectal cancer, a substantial local recurrence rate is observed. Patients with recurrent Tis/T1 cancers who undergo a salvage operation may achieve good long-term outcome. Local treatment without adjuvant therapy for T2 rectal cancers appears inadequate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Adams DR, Blatchford GJ, Lin KM, Ternent CA, Thorson AG, Christensen MA (1999) Use of preoperative ultrasound staging for treatment of rectal cancer. Dis Colon Rectum 42: 159–166

    Article  CAS  PubMed  Google Scholar 

  2. Beynon J, Roe AM, Foy DM, Channer JL, Virjee J, Mortensen NJ (1987) Preoperative staging of local invasion in rectal cancer using endoluminal ultrasound. J R Soc Med 80: 23–24

    CAS  PubMed  Google Scholar 

  3. Blumberg D, Paty PB, Guillem JG, Picon AI, Minsky BD, Wong WD, Cohen A (1999) All patients with small intramural rectal cancers are at risk for lymph node metastasis. Dis Colon Rectum 42: 881–885

    Article  CAS  PubMed  Google Scholar 

  4. Bosset JF, Magnin V, Maingon P, Mantion G, Pelissier EP, Mercier M, Chaillard G, Horiot JC (2000) Preoperative radiochemotherapy in rectal cancer: long-term results of a phase II trial. Int J Radiat Oncol Biol Phys 46: 323–327

    Article  CAS  PubMed  Google Scholar 

  5. Buess G, Theiss R, Hutterer F, Pichlmaier H, Pelz C, Holfeld T, Said S, Isselhard (1983) Transanal endoscopic surgery of the rectum: testing a new method in animal experiments. Leber Magen Darm 13: 73–77

    CAS  PubMed  Google Scholar 

  6. Church JM, Gibbs P, Chao MW, Tjandra J (2003) Optimizing the outcome for patients with rectal cancer. Dis Colon Rectum 46: 389–402

    PubMed  Google Scholar 

  7. Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguilar J (2002) Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum 45: 875–879

    Article  PubMed  Google Scholar 

  8. Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff RD, Rothenberger DA (2000). Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg 231: 345–351

    Article  CAS  PubMed  Google Scholar 

  9. Garcia-Aguilar J, Pollack J, Lee SH, Hernandez de Anda E, Mellgren A, Wong WD, Finne CO, Rothenberger DA, Madoff RD (2002) Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors. Dis Colon Rectum 45: 10–15

    PubMed  Google Scholar 

  10. Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133: 894–899

    CAS  PubMed  Google Scholar 

  11. Hildebrandt U, Feifel G, Schwarz HP, Scherr O (1986) Endorectal ultrasound: instrumentation and clinical aspects. Int J Colorectal Dis 1: 203–207

    Article  CAS  PubMed  Google Scholar 

  12. Langer C, Liersch T, Markus P, Suss M, Ghadimi M, Fuzesi L, Becker H (2002) Transanal endoscopic microsurgery (TEM) for minimally invasive resection of rectal adenomas and “low-risk” carcinomas (uT1, G1 – 2). Z Gastroenterol 40: 67–72

    Article  CAS  PubMed  Google Scholar 

  13. Langer C, Liersch T, Suss M, Siemer A, Markus P, Ghadimi BM, Fuzesi L, Becker H (2003) Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection. Int J Colorectal Dis 18: 222–229

    CAS  PubMed  Google Scholar 

  14. Lezoche E, Guerrieri M, Paganini AM, Feliciotti F (2002) Long-term results of patients with pT2 rectal cancer treated with radiotherapy and transanal endoscopic microsurgical excision. World J Surg 26: 1170–1174

    Article  PubMed  Google Scholar 

  15. Parks AG, Stuart AE (1973) The management of villous tumours of the large bowel. Br J Surg 60: 688–695

    CAS  PubMed  Google Scholar 

  16. Paty PB, Nash GM, Baron P, Zakowski M, Minsky BD, Blumberg D, Nathanson DR, Guillem JG, Enker WE, Cohen AM, Wong WD (2002) Long-term results of local excision for rectal cancer. Ann Surg 236: 522–529, discussion 529–530

    Article  PubMed  Google Scholar 

  17. Said S, Huber P, Pichlmaier H (1993) Technique and clinical results of endorectal surgery. Surgery 113: 65–75

    CAS  PubMed  Google Scholar 

  18. Winde G, Nottberg H, Keller R, Schmid KW, Bunte H (1996) Surgical cure for early rectal carcinomas (T1): transanal endoscopic microsurgery vs anterior resection. Dis Colon Rectum 39: 969–976

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Surgery, S. Giovanni Hospital Rome, via Salaria 332, Rome, 00199, Italy

    F. Stipa, A. Burza, G. Lucandri & A. Pigazzi

  2. University of Rome “La Sapienza”, Rome, Italy

    M. Ferri, V. Ziparo & S. Stipa

  3. University of Cagliari, Cagliari, Italy

    G. Casula

Authors
  1. F. Stipa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Burza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Lucandri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Ferri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Pigazzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Ziparo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Casula
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. Stipa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Stipa.

Additional information

Presented in part at the Annual Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) meeting, Ft Lauderdale, FL, USA, 13–16 April 2005

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stipa, F., Burza, A., Lucandri, G. et al. Outcomes for early rectal cancer managed with transanal endoscopic microsurgery. Surg Endosc 20, 541–545 (2006). https://doi.org/10.1007/s00464-005-0408-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-005-0408-y

Keywords

Search

Navigation