Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum
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- Heintz, A., Mörschel, M. & Junginger, T. Surg Endosc (1998) 12: 1145. doi:10.1007/s004649900802
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Background: We compared the results of transanal endoscopic microsurgery and radical surgery in patients with T1 carcinomas of the rectum.
Methods: We performed a retrospective study (1985–96) to compare the results obtained in 103 patients with T1 rectal carcinomas (low-risk T1, n= 80; high-risk T1; n= 23) undergoing transanal endoscopic microsurgery and radical surgical therapy.
Results: The complication rate in patients undergoing local excision was 3.4% (two of 58); it was 18% (eight of 45) in the group treated with radical surgery. Two of 45 patients (3.8%) died after radical resection; there were no deaths after local excision. With regard to the actuarial 5-year survival rate, no difference was observed in the group with low-risk T1 carcinoma between patients treated with local excision (79%) and those who had radical resection (81%) (p= 0.72). In patients with high-risk T1 carcinoma, lymph node metastases were identified in four of 11 patients undergoing radical resection (36%). Four of 12 patients with high-risk T1 carcinoma treated by local excision developed recurrences, whereas none of the patients undergoing primary radical surgery had a recurrence.
Conclusions: Transanal endoscopic microsurgery for the treatment of low-risk T1 carcinomas is associated with a significantly lower complication rate than radical surgical therapy. There is no difference in 5-year survival between local and radical surgical therapy in patients with low-risk T1 carcinoma.