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Outcome of Transanal Endoscopic Microsurgery and Adjuvant Radiotherapy in Patients with T2 Rectal Cancer

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

The use of transanal endoscopic microsurgery for local excision of rectal cancer has recently gained wide acceptance as a valid and safe alternative for the surgical treatment of T1 tumors. The adequacy of such treatment for T2 tumors, however, is still controversial. This study was designed to evaluate our results with local excision of T2 cancers.

Methods

Patients with T2 cancer admitted to our hospital between 1995 and 2005 were offered surgery by transanal endoscopic microsurgery if found medically unfit or were unwilling to undergo radical surgery. Patients who were preoperatively staged as T1 tumor but were found to be pathologically T2 also were included.

Results

Overall, we performed 59 transanal endoscopic microsurgery operations for rectal cancers, of which 21 were for T2 cancers. In 16 (76 percent) of the T2 patients, the tumors were completely removed with clear margins by transanal endoscopic microsurgery and no additional surgery was performed, except for 2 patients who developed radiation-induced complications. Radical surgery was performed in a second operation in five patients because of involved margins and residual disease was found in two. At a median follow-up of three years, all 12 patients who received local excision and radiotherapy remained disease free, whereas a 50 percent recurrence rate was observed in patients who refused adjuvant radiotherapy.

Conclusions

The results of this study support the feasibility of transanal endoscopic microsurgery for the treatment of selected patients with T2 rectal cancer. The addition of radiotherapy may decrease the rates of early local recurrence. However, at present, this treatment strategy should not be routinely considered for patients who may undergo radical procedures.

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References

  1. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986;1:1479–82.

    Article  PubMed  CAS  Google Scholar 

  2. Danzi M, Ferulano GP, Abates S, Dilillo S, Califano G. Survival and locations of recurrence following abdomino-perineal resection for rectal cancer. J Surg Oncol 1986;311:235–9.

    Article  Google Scholar 

  3. Nesbakken A, Nygaard K, Bull-Njaa T, Carlsen E, Eri LM. Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg 2000;87:206–10.

    Article  PubMed  CAS  Google Scholar 

  4. Chakravarti A, Compton CC, Shellito PC, et al. Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg 1999;230:49–54.

    Article  PubMed  CAS  Google Scholar 

  5. Graham RA, Garnsey L, Jessap JM. Local excision of rectal carcinoma. Am J Surg 1990;160:306–12.

    Article  PubMed  CAS  Google Scholar 

  6. Read DR, Sokil S, Ruiz-Salas G. Transanal excision of rectal cancer. Int J Colorectal Dis 1995;10:73–6.

    Article  PubMed  CAS  Google Scholar 

  7. Buess G, Hutterer F, Theiss J, Bobel M, Isselhard W, Pichlmaier H. Das system fur die transanale endoskopische rectumoperation. Chirurg 1984;55:677–80.

    PubMed  CAS  Google Scholar 

  8. Buess G, Mentges B, Manncke K, Stalinger M, Becker HD. Technique and results of transanal endoscopic microsurgery in early rectal cancer. Am J Surg 1992;230:63–70.

    Article  Google Scholar 

  9. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Is local excision adequate therapy for early rectal cancer. Dis Colon Rectum 2000;43:1064–74.

    Article  PubMed  CAS  Google Scholar 

  10. Smith LE, Ko ST, Saclarides T, Caushaj P, Orkin BA, Khanduja KS. Transanal endoscopic microsurgery. Initial registry results. Dis Colon Rectum 1996;39(Suppl):S79–84.

    Article  PubMed  CAS  Google Scholar 

  11. Graff EJ, Doornebosch PG, Stassen LP, Debets JM, Tetteroo GW, Hop WC. Transanal endoscopic microsurgery for rectal cancer. Eur J Cancer 2002;38:904–10.

    Article  Google Scholar 

  12. Blair S, Ellenhorn JD. Transanal excision for low rectal cancer is curative in early stage disease with favorable histology. Am Surg 2000;66:811–20.

    Google Scholar 

  13. Sengupta S, Tjandra JJ. Local excision of rectal cancer: what is the evidence? Dis Colon Rectum 2001;44:1345–61.

    Article  PubMed  CAS  Google Scholar 

  14. Winde G, Nottberg Keller HR, Schmid KW, Bunte H. Surgical cure for early rectal carcinomas (T1): transanal endoscopic microsurgery vs. anterior resection. Dis Colon Rectum 1996;39:969–76.

    Article  PubMed  CAS  Google Scholar 

  15. Hershman MJ, Sun Myint A, Makin CA. Multi-modality approach in curative local treatment of early rectal carcinomas. Colorectal Dis 2002;5:445–50.

    Article  Google Scholar 

  16. Lezoche E, Guerrieri M, Paganini AM, Feliciotti F. Long-term results of patients with pT2 rectal cancer with radiotherapy and transanal endoscopic microsurgical excision. World J Surg 2002;26:1170–4.

    Article  PubMed  Google Scholar 

  17. Lezoche E, Guerrieri M, Paganini AM, Feliciotti F. Transanal endoscopic microsurgery for irradiated and nonirradiated rectal cancer. A 5 years experience. Surg Laparosc Endosc 1998;8:249–56.

    Article  PubMed  CAS  Google Scholar 

  18. Dafnis G, Pahlman L, Raab Y, Gustafsson UM, Graf W. Transanal endoscopic microsurgery: clinical and functional results. Colorectal Dis 2004;6:336–42.

    Article  PubMed  CAS  Google Scholar 

  19. Lee W, Lee D, Choi S, Chun H. Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer. Surg Endosc 2003;17:1283–7.

    Article  PubMed  CAS  Google Scholar 

  20. Lezoche E, Guerrieri M, Pagnini AM. Transanal endoscopic microsurgery vs. total mesorectal laparoscopic resections of T2-N0 low rectalcancers after neoadjuvant treatment. Surg Endosc 2005;19:751–6.

    Article  PubMed  CAS  Google Scholar 

  21. Duek SD, Krausz MM, Hershko DD. Transanal endoscopic microsurgery for rectal cancer. Isr Med Assoc J 2005;7:435–8.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Unit of Colorectal Surgery, Rambam Medical Center and The Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

    Simon D. Duek M.D. & Nidal Issa M.D.

  2. Department of Surgery, Rambam Medical Center and The Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

    Simon D. Duek M.D., Dan D. Hershko M.D. & Michael M. Krausz M.D.

Authors
  1. Simon D. Duek M.D.
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  2. Nidal Issa M.D.
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  3. Dan D. Hershko M.D.
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  4. Michael M. Krausz M.D.
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Correspondence to Simon D. Duek M.D..

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Duek, S.D., Issa, N., Hershko, D.D. et al. Outcome of Transanal Endoscopic Microsurgery and Adjuvant Radiotherapy in Patients with T2 Rectal Cancer. Dis Colon Rectum 51, 379–384 (2008). https://doi.org/10.1007/s10350-007-9164-5

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  • DOI: https://doi.org/10.1007/s10350-007-9164-5

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