Abstract
Local excision for benign rectal lesions and T1 rectal cancers has become technically possible with the introduction of transanal endoscopic microsurgery and transanal minimally invasive surgery. This option is increasingly more appealing for both the patient and surgeon as it results in significantly reduced surgical morbidity compared to radical surgery. However, in some patients, local excision may reveal unfavorable pathological features that may then mandate radical resection. Immediate salvage surgery in this situation results in equivalent survival rates to upfront radical resection; however, the salvage operation may be more technically challenging, resulting in poorer functional outcomes. Local recurrence is another indication for salvage surgery after local excision of early rectal cancers. Both local recurrence rates and stage at which the recurrence occurs are found to be greater in patients who recur after local excision compared to upfront proctectomy with total mesorectal excision. Resulting survival outcomes are disappointing despite aggressive and extensive surgical resection to achieve tumor-free results. Ultimately careful patient selection and aggressive surveillance should be implemented in patients who undergo local excision for early rectal cancer.
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References
Chang HC, Huang SC, Chen JS, Tang R, Changchien CR, Chiang JM, et al. Risk factors for lymph node metastasis in pT1 and pT2 rectal cancer: a single-institute experience in 943 patients and literature review. Ann Surg Oncol. 2012;19(8):2477–84.
Rasheed S, Bowley DM, Aziz O, Tekkis PP, Sadat AE, Guenther T, et al. Can depth of tumour invasion predict lymph node positivity in patients undergoing resection for early rectal cancer? A comparative study between T1 and T2 cancers. Color Dis. 2008;10(3):231–8.
Bach SP, Hill J, Monson JR, Simson JN, Lane L, Merrie A, et al. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg. 2009;96(3):280–90.
Borschitz T, Heintz A, Junginger T. The influence of histopathologic criteria on the long-term prognosis of locally excised pT1 rectal carcinomas: results of local excision (transanal endoscopic microsurgery) and immediate reoperation. Dis Colon Rectum. 2006;49(10):1492–506. discussion 500-5
Hahnloser D, Wolff BG, Larson DW, Ping J, Nivatvongs S. Immediate radical resection after local excision of rectal cancer: an oncologic compromise? Dis Colon Rectum. 2005;48(3):429–37.
Baron PL, Enker WE, Zakowski MF, Urmacher C. Immediate vs. salvage resection after local treatment for early rectal cancer. Dis Colon Rectum. 1995;38(2):177–81.
Levic K, Bulut O, Hesselfeldt P, Bulow S. The outcome of rectal cancer after early salvage surgery following transanal endoscopic microsurgery seems promising. Dan Med J. 2012;59(9):A4507.
van Gijn W, Brehm V, de Graaf E, Neijenhuis PA, Stassen LP, Leijtens JW, et al. Unexpected rectal cancer after TEM: outcome of completion surgery compared with primary TME. Eur J Surg Oncol. 2013;39(11):1225–9.
Paty PB, Nash GM, Baron P, Zakowski M, Minsky BD, Blumberg D, et al. Long-term results of local excision for rectal cancer. Ann Surg. 2002;236(4):522–9. discussion 9-30
Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff RD, Rothenberger DA. Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg. 2000;231(3):345–51.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): Rectal Cancer. Version 1.2018 2018. Available from: https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf.
Doornebosch PG, Ferenschild FT, de Wilt JH, Dawson I, Tetteroo GW, de Graaf EJ. Treatment of recurrence after transanal endoscopic microsurgery (TEM) for T1 rectal cancer. Dis Colon Rectum. 2010;53(9):1234–9.
de Anda EH, Lee SH, Finne CO, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Endorectal ultrasound in the follow-up of rectal cancer patients treated by local excision or radical surgery. Dis Colon Rectum. 2004;47(6):818–24.
Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguilar J. Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum. 2002;45(7):875–9.
Bikhchandani J, Ong GK, Dozois EJ, Mathis KL. Outcomes of salvage surgery for cure in patients with locally recurrent disease after local excision of rectal cancer. Dis Colon Rectum. 2015;58(3):283–7.
Weiser MR, Landmann RG, Wong WD, Shia J, Guillem JG, Temple LK, et al. Surgical salvage of recurrent rectal cancer after transanal excision. Dis Colon Rectum. 2005;48(6):1169–75.
You YN, Roses RE, Chang GJ, Rodriguez-Bigas MA, Feig BW, Slack R, et al. Multimodality salvage of recurrent disease after local excision for rectal cancer. Dis Colon Rectum. 2012;55(12):1213–9.
Landmann RG, Wong WD, Hoepfl J, Shia J, Guillem JG, Temple LK, et al. Limitations of early rectal cancer nodal staging may explain failure after local excision. Dis Colon Rectum. 2007;50(10):1520–5.
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Hoang, S.C., Friel, C.M. (2019). Salvage Surgery After TAMIS Excision of Early-Stage Rectal Cancer. In: Atallah, S. (eds) Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME). Springer, Cham. https://doi.org/10.1007/978-3-030-11572-2_5
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DOI: https://doi.org/10.1007/978-3-030-11572-2_5
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