Abstract
Background: Transanal endoscopic microsurgery (TEM) has gained increasing acceptance as a local treatment of early rectal cancer. The purpose of this study was to compare the results of TEM and radical surgery in patients with T1 and T2 rectal cancer. Methods: From October 1994 to December 2000, 74 patients with T1 and T2 rectal adenocarcinoma treated with TEM were compared with 100 patients with T1N0M0 and T2N0M0 rectal adenocarcinoma treated with radical surgery. Retrospective analysis was performed regarding to recurrence and survival rate. Neither group received adjuvant chemoradiation. There was no significant difference in age, gender, tumor location, or follow-up period between the two groups. The only difference was in tumor size. Results: Of the 74 patients in TEM group, 52 were T1 (70.3%) and 22 were T2 (29.7%). Of the 100 patients in radical surgery group, 17 were T1 (17%) and 83 patients were T2 (83%). The 5-year local recurrence rates were 4.1% for T1, 19.5% for T2 after TEM, 0% for T1, and 9.4% for T2 after radical surgery. There was no statistical difference between the TEM and radical surgery groups for T1 rectal cancer (p = 0.95), but for T2 rectal cancer, the 5-year local recurrence rate was higher after TEM than after radical surgery (p = 0.04). There were no significant statistical difference between the two groups in terms of the 5-year disease-free survival rate and the survival rate. Conclusions: For T1 rectal cancer, there was no difference in recurrence or 5-year survival rate between the TEM and the radical surgery groups. For T2 rectal cancer, there was no statistical difference in the 5-year survival rate between the two groups, but TEM carried higher risk of local recurrence. Therefore, careful selection of the patients is required for TEM, and when proper muscle invasion is proven, the TEM procedure should be supplemented by further treatment, or radical surgery should be performed.
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References
RJ Aitken (1996) ArticleTitleMesorectal excision for rectal cancer. Br J Surg 83 214–216 Occurrence Handle10.1046/j.1365-2168.1996.02057.x Occurrence Handle1:STN:280:BymB2cnps1w%3D Occurrence Handle8689166
R Bleday E Breen JM Jessup A Burgess SM Sentovich G Steele Jr (1997) ArticleTitleProspective evaluation of local excision for small rectal cancers. Dis Colon Rectum 40 388–392 Occurrence Handle1:STN:280:ByiB28%2Fls1E%3D Occurrence Handle9106685
G Buess K Kipfmuller R Ibald A Heintz T Junginger (1988) ArticleTitleClinical results of transanal endoscopic microsurgery. Surg Endosc 2 245–250 Occurrence Handle1:STN:280:BiaB3czmsVI%3D Occurrence Handle3071872
G Buess B Mentges K Manncke M Stalinger HD Becker (1992) ArticleTitleTechnique and results of transanal endoscopic microsurgery in early rectal cancer. Am J Surg 163 63–70 Occurrence Handle1:STN:280:By2C38rmt1E%3D Occurrence Handle1733375
A Chakravarti CC Compton PC Shellito WC Wood J Landry SR Machuta (1999) ArticleTitleLong-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg 230 49–54 Occurrence Handle10.1097/00000658-199907000-00008 Occurrence Handle1:STN:280:DyaK1MzisFKhsQ%3D%3D
RA Graham L Garnsey JM Jessup (1990) ArticleTitleLocal excision of rectal carcinoma. Am J Surg 160 306–312 Occurrence Handle1:STN:280:By%2BA28rhsFU%3D Occurrence Handle2203268
RJ Heald RD Ryall (1986) ArticleTitleRecurrence and survival after total mesorectal excision for rectal cancer. Lancet 1 1479–1482 Occurrence Handle1:STN:280:BimB2Mros1w%3D Occurrence Handle2425199
A Heintz M Morschel T Junginger (1998) ArticleTitleComparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc 12 1145–1148 Occurrence Handle10.1007/s004649900802 Occurrence Handle1:STN:280:DyaK1czosVClsQ%3D%3D Occurrence Handle9716769
P Hermanek FP Gall (1986) ArticleTitleEarly colorectal carcinoma. Int J Colorectal Dis 1 79–84 Occurrence Handle1:STN:280:BiiB1c3gt1w%3D Occurrence Handle3611938
E Lezoche M Guerrieri A Paganini F Feliciotti FD Pietrantonj (1996) ArticleTitleIs transanal endoscopic microsurgery (TEM) a valid treatment for rectal tumors? Surg Endosc 10 736–741 Occurrence Handle10.1007/s004649900145 Occurrence Handle1:STN:280:BymB1c7mtVY%3D Occurrence Handle8662430
E Lezoche M Guerrieri A Paganini F Feliciotti FD Pietrantonj (1998) ArticleTitleTransanal endoscopic microsurgical excision of irradiated and nonirradiated rectal cancer: a 5-year experience. Surg Laparosc Endosc 8 249–256 Occurrence Handle10.1097/00019509-199808000-00001 Occurrence Handle1:STN:280:DyaK1czmvFaitQ%3D%3D Occurrence Handle9703594
D McCready D Ota T Rich D Thielvolt M Jessup (1989) ArticleTitleProspective phase 1 trial of conservative management of local rectal lesions. Arch Surg 124 67–70 Occurrence Handle1:STN:280:BiaD1cjivFU%3D Occurrence Handle2910250
A Mellgren P Sirivongs DA Rothenberger RD Madoff J Garcia-Aguilar (2000) ArticleTitleIs local excision adequate therapy for early rectal cancer? Dis Colon Rectum 43 1064–1074
BD Minsky T Rich A Recht W Harvey C Mies (1989) ArticleTitleSelection criteria for local excision with or without adjuvant radiation therapy for rectal caner. Cancer 63 1421–1429 Occurrence Handle1:STN:280:BiaC2M7is1A%3D Occurrence Handle2920368
S Nivatvongs (2000) ArticleTitleSurgical management of early colorectal cancer. World J Surg 24 1052–1055 Occurrence Handle10.1007/s002680010148 Occurrence Handle1:STN:280:DC%2BD3cvos12mtw%3D%3D Occurrence Handle11036281
LE Smith ST Ko T Saclarides P Caushaj BA Orkin KS Khanduja (1996) ArticleTitleTransanal endoscopic microsurgery: initial registry results. Dis Colon Rectum 39 IssueID10 Suppl s79–s84 Occurrence Handle1:STN:280:BymH38fksV0%3D Occurrence Handle8831552
MJ Solomon RS McLeod (1993) ArticleTitleEndoluminal transrectal ultrasonography: accuracy, reliability, and validity. Dis Colon Rectum 36 200–205 Occurrence Handle1:STN:280:ByyC2crnvFA%3D Occurrence Handle8425429
InstitutionalAuthorNameSwedish Rectal Cancer Trial (1997) ArticleTitleImproved survival with preoperative radiotherapy in rectal carcinoma. N Engl J Med 336 980–987 Occurrence Handle10.1056/NEJM199704033361402 Occurrence Handle9091798
RH Talyor JH Hay SN Larsson (1998) ArticleTitleTransanal local excision of selected low rectal cancers. Am J Surg 175 360–363 Occurrence Handle10.1016/S0002-9610(98)00038-5 Occurrence Handle1:STN:280:DyaK1c3mtV2jtg%3D%3D Occurrence Handle9600277
G Winde H Nottberg R Keller KW Schmid H Bunte (1996) ArticleTitleSurgical cure for early rectal carcinoma (T1). Dis Colon Rectum 39 969–976 Occurrence Handle1:STN:280:BymA1M%2FmslQ%3D Occurrence Handle8797643
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Lee, W., Lee, D., Choi, S. et al. Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer . Surg Endosc 17, 1283–1287 (2003). https://doi.org/10.1007/s00464-002-8814-x
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DOI: https://doi.org/10.1007/s00464-002-8814-x