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Journal of Gastrointestinal Surgery

, Volume 16, Issue 12, pp 2280–2287 | Cite as

Transanal Endoscopic Microsurgery vs. Laparoscopic Total Mesorectal Excision for T2N0 Rectal Cancer

  • Marco Ettore Allaix
  • Alberto Arezzo
  • Giuseppe Giraudo
  • Mario MorinoEmail author
Original Article

Abstract

Objective

The aim was to compare transanal endoscopic microsurgery (TEM) and laparoscopic resection (LR) in terms of short-term and oncologic outcomes in patients with a preoperatively diagnosed T2N0 extraperitoneal rectal cancer.

Methods

We conducted a retrospective analysis of a prospective database. All patients with a preoperatively staged T2N0 extraperitoneal rectal adenocarcinoma were considered for LR. Patients refusing LR or medically unfit for LR were considered for TEM, which was associated with neoadjuvant RT in the last cases. Only patients with a minimum follow-up of 36 months were included.

Results

Seventy-eight patients were included. TEM was indicated or preferred in 43 patients; of these, 11 underwent neoadjuvant RT. Morbidity was significantly lower after TEM (p < 0.001). The median follow-up was 70 (36–140) months. A higher local recurrence rate was noted after TEM (26 %), compared to neoadjuvant RT + TEM (0 %) and LR (9 %) (p = 0.070). Overall, 5-year survival rate was 76 % after TEM, 77.8 % after RT + TEM, and 96 % after LR, respectively (p = 0.134).

Conclusions

While TEM alone may only be considered a palliative treatment, it might allow similar oncologic results to abdominal resection in responders to neoadjuvant RT. Large prospective randomized trials are awaited to confirm these findings.

Keywords

Transanal endoscopic microsurgery Neoadjuvant radiotherapy Laparoscopy Total mesorectal excision Rectal cancer 

Notes

Conflict of interest

None.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Marco Ettore Allaix
    • 1
  • Alberto Arezzo
    • 1
  • Giuseppe Giraudo
    • 1
  • Mario Morino
    • 1
    Email author
  1. 1.Digestive, Colorectal, Oncologic and Minimal Invasive SurgeryUniversity of TorinoTorinoItaly

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