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Analysis of local recurrences after transanal endoscopic microsurgery for low risk rectal carcinoma

International Journal of Colorectal Disease volume 32, pages 265–271 (2017)Cite this article

Abstract

Aim

Rates of local recurrence (LR) after transanal endoscopic microsurgery (TEM) for rectal carcinoma vary; the reasons remain unclear. We analyzed LR after TEM for low-risk pT1 (G1/2/X, L0/X) rectal carcinoma to investigate the influence of completeness of resection and occult lymph node metastasis on risk of LR.

Method

LR location and stage, completeness of resection of primary carcinoma (minimal distance between tumor and resection line ≤1 mm vs >1 mm), and incidence of involved lymph nodes in resected LR specimens were collected, and tumor characteristics of LR were compared with primary carcinoma. Distant metastasis and overall and cancer-specific survival were determined.

Results

LR developed in 14 patients; in 2/4 with R1/X resection, in 3/8 (38%) with clear margins (R0) but a minimal distance of ≤1 mm, and in 9/88 (10%) with formally complete resection. Six of nine patients with formally complete resection underwent radical surgery for LR; in five out of these six, lymph nodes were not involved. In 5/14 patients, LR was poorly differentiated compared to primary carcinoma. Main LR causes were incomplete tumor resection or tumor persistence after formally complete resection. Overall (p = 0.008) and cancer-specific (p < 0.001) survival was lower in LR patients compared to non-LR patients, even if lymph nodes were uninvolved.

Conclusions

The results suggest that most LRs after TEM for low-risk rectal cancer were caused by residual tumor at the previous excision site and not by undetected lymph node metastases. By improved standardization of surgical techniques to ensure complete resection of carcinomas and thorough pathological assessments, most LRs seem to be avoidable.

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Acknowledgements

The authors confirm that they were not supported by any grants, equipment, or organizations.

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Affiliations

  1. Department of General and Abdominal Surgery, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany

    Theodor Junginger & Ursula Goenner

  2. Department of General, Visceral and Vascular Surgery, Catholic Hospital Mainz, Mainz, Germany

    Mirjam Hitzler & Achim Heintz

  3. Department of Heart, Chest and Vascular Surgery, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Tong T. Trinh

  4. Institute of Pathology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Wilfried Roth

  5. Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Maria Blettner & Daniel Wollschlaeger

Authors
  1. Theodor Junginger
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  2. Ursula Goenner
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  3. Mirjam Hitzler
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  4. Tong T. Trinh
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  5. Achim Heintz
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  6. Wilfried Roth
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  7. Maria Blettner
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  8. Daniel Wollschlaeger
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Correspondence to Theodor Junginger.

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Junginger, T., Goenner, U., Hitzler, M. et al. Analysis of local recurrences after transanal endoscopic microsurgery for low risk rectal carcinoma. Int J Colorectal Dis 32, 265–271 (2017). https://doi.org/10.1007/s00384-016-2715-2

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  • DOI: https://doi.org/10.1007/s00384-016-2715-2

Keywords

  • Low-risk rectal carcinoma
  • Transanal endoscopic microsurgery
  • Local recurrence
  • Causes of local recurrence