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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

  • Published:
Diseases of the Colon & Rectum

Purpose

Local excision of early rectal cancer is a controversial issue, which is in part because of differences in the evaluation of histopathologic criteria. This prospective study was designed to determine prognostic factors for recurrences and the need for reoperation.

Methods

In 105 of 118 patients with pT1 carcinomas and local excision, results of recurrence rates and ten-year cancer-free survival were studied separately according to different histologic criteria (R0, R1, Rx, R ≤ 1 mm, high-/low-risk situation), tumor localization (anterior, posterior, lateral wall and third of rectum), size, and degree of resection (full-thickness/partial wall). Patients were grouped into local excision (n = 89) and local excision followed by reoperation (n = 21). Risk classification was performed by division into “low-risk” carcinomas after local R0-resection (Group A) and unfavorable histologic results after local resection (R1, Rx, R ≤ 1 mm, high-risk situation; Group B).

Results

Local recurrence rates after local R0-resection of low-risk carcinomas were 6 percent, whereas patients in Group B with local resection were 39 percent. The recurrence risk in those patients was significantly reduced to 6 percent by reoperation (P = 0.015). In addition, ten-year, cancer-free survival was 93 percent in Group B after reoperation compared with 89 percent in patients of Group A after local excision alone.

Conclusions

Local R0-resection in cases with low-risk pT1 carcinomas represents an oncologically adequate therapy, which results in similar survival rates compared with primary radical surgery of pT1N0M0 rectal carcinomas. High recurrence rates are observed in tumors with unfavorable histologic result (Group B) requiring further treatment. In these cases immediate reoperation reduces the recurrence rate to 6 percent.

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References

To the Article

  1. S Said JM Müller (1997) ArticleTitleTEM-minimal invasive therapy of rectal cancer? Swiss Surg 3 248–254 Occurrence Handle9427863 Occurrence Handle1:STN:280:DyaK1c%2FovFeisw%3D%3D

    PubMed  CAS  Google Scholar 

  2. T Borschitz T Junginger (2003) ArticleTitleValue of local surgical therapy of rectal cancer. A literature analysis Zentralbl Chir 128 1066–1074 Occurrence Handle14750068 Occurrence Handle1:STN:280:DC%2BD2c%2FkvFensg%3D%3D Occurrence Handle10.1055/s-2003-44846

    Article  PubMed  CAS  Google Scholar 

  3. S Sengupta JJ Tjandra (2001) ArticleTitleLocal excision of rectal cancer:what is the evidence? Dis Colon Rectum 44 1345–1361 Occurrence Handle11584215 Occurrence Handle1:STN:280:DC%2BD3MrjsFWmsw%3D%3D Occurrence Handle10.1007/BF02234796

    Article  PubMed  CAS  Google Scholar 

  4. A Sharma J Hartley JR Monson (2003) ArticleTitleLocal excision of rectal tumours Surg Oncol 12 51–61 Occurrence Handle12689670 Occurrence Handle10.1016/S0960-7404(03)00007-0

    Article  PubMed  Google Scholar 

  5. AY Mason (1976) ArticleTitlePresident’s address. Rectal cancer: the spectrum of elective surgery Proc R Soc Med 69 237–244 Occurrence Handle772683 Occurrence Handle1:STN:280:DyaE287ns1Gltw%3D%3D

    PubMed  CAS  Google Scholar 

  6. G Buess F Hutterer J Theiss M Bobel W Isselhard H Pichlmaier (1984) ArticleTitleA system for a transanal endoscopic rectum operation Chirurg 55 677–680 Occurrence Handle6510078 Occurrence Handle1:STN:280:BiqD2srpt1I%3D

    PubMed  CAS  Google Scholar 

  7. InstitutionalAuthorNameUICC (1997) NoChapterTitle LH Sobin C Wittekind (Eds) TNM Classification of malignant tumours EditionNumber5th ed. Wiley New York

    Google Scholar 

  8. P Hermanek (1978) ArticleTitleA pathologist’s point of view on endoscopically removed polyps of the colon and rectum Acta Hepatogastroenterol (Stuttg) 25 169–170 Occurrence Handle1:STN:280:CSeB3cjksVc%3D

    CAS  Google Scholar 

  9. P Hermanek FP Gall (1986) ArticleTitleEarly (microinvasive) colorectal carcinoma. Pathology, diagnosis, surgical treatment Int J Colorectal Dis 1 79–84 Occurrence Handle3611938 Occurrence Handle1:STN:280:BiiB1c3gt1w%3D Occurrence Handle10.1007/BF01648411

    Article  PubMed  CAS  Google Scholar 

  10. T Ambacher R Kasperk V Schumpelick (1990) ArticleTitleTumor recurrence after transanal excision of stage I rectal cancer in comparison with radical resection Chirurg 70 1469–1474 Occurrence Handle10.1007/s001040050088

    Article  Google Scholar 

  11. RP Billingham (1992) ArticleTitleConservative treatment of rectal cancer. Extending the indications Cancer 70 IssueIDSuppl 1355–1363 Occurrence Handle1511385 Occurrence Handle1:STN:280:By2A2sbntFE%3D Occurrence Handle10.1002/1097-0142(19920901)70:3+<1355::AID-CNCR2820701525>3.0.CO;2-9

    Article  PubMed  CAS  Google Scholar 

  12. GF Buess (1995) ArticleTitleLocal surgery treatment of rectal cancer Eur J Cancer 31A 1233–1237 Occurrence Handle7577029 Occurrence Handle1:STN:280:BymD2cnjtlI%3D Occurrence Handle10.1016/0959-8049(95)00240-J

    Article  PubMed  CAS  Google Scholar 

  13. J Garcia-Aguilar A Mellgren P Sirivongs D Buie RD Madoff DA Rothenberger (2000) ArticleTitleLocal excision of rectal cancer without adjuvant therapy: a word of caution Ann Surg 231 345–351 Occurrence Handle10714627 Occurrence Handle1:STN:280:DC%2BD3c7nslWjuw%3D%3D Occurrence Handle10.1097/00000658-200003000-00007

    Article  PubMed  CAS  Google Scholar 

  14. RA Graham L Garnsey LM Jessup (1990) ArticleTitleLocal excision of rectal cancer Am J Surg 160 306–312 Occurrence Handle2203268 Occurrence Handle1:STN:280:By%2BA28rhsFU%3D

    PubMed  CAS  Google Scholar 

  15. A Heintz S Braunstein H Menke (1992) ArticleTitleLocal excision of rectal tumors. Indications, preoperative diagnosis, surgical technique and results Med Klin (Munich) 87 236–241 Occurrence Handle1:STN:280:By2A3M%2Fjt1c%3D

    CAS  Google Scholar 

  16. A Heintz M Morschel T Junginger (1998) ArticleTitleComparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum Surg Endosc 12 1145–1148 Occurrence Handle9716769 Occurrence Handle1:STN:280:DyaK1czosVClsQ%3D%3D Occurrence Handle10.1007/s004649900802

    Article  PubMed  CAS  Google Scholar 

  17. C Langer T Liersch P Markus et al. (2002) ArticleTitleTransanal endoscopic microsurgery (TEM) for minimally invasive resection of rectal adenomas and “low-risk” carcinomas (uT1, G1-2) Z Gastroenterol 40 67–72 Occurrence Handle11857100 Occurrence Handle1:STN:280:DC%2BD387mt1Oktw%3D%3D Occurrence Handle10.1055/s-2002-20210

    Article  PubMed  CAS  Google Scholar 

  18. DG Kim RD Madoff (1998) ArticleTitleTransanal treatment of rectal cancer: ablative methods and open resection Semin Surg Oncol 15 101–113 Occurrence Handle9730416 Occurrence Handle1:STN:280:DyaK1czpvVWrtg%3D%3D Occurrence Handle10.1002/(SICI)1098-2388(199809)15:2<101::AID-SSU7>3.0.CO;2-3

    Article  PubMed  CAS  Google Scholar 

  19. B Mentges G Buess G Effinger K Manncke HD Becker (1997) ArticleTitleIndications and results of local treatment of rectal cancer Br J Surg 84 348–351 Occurrence Handle9117305 Occurrence Handle1:STN:280:ByiB3s3ht1A%3D Occurrence Handle10.1002/bjs.1800840324

    Article  PubMed  CAS  Google Scholar 

  20. GD Sakamoto JM MacKeigan AJ Senagore (1991) ArticleTitleTransanal excision of large, rectal villous adenomas Dis Colon Rectum 34 880–885 Occurrence Handle1914721 Occurrence Handle1:STN:280:By2D3cnpsF0%3D Occurrence Handle10.1007/BF02049701

    Article  PubMed  CAS  Google Scholar 

  21. W Slisow KT Moesta PM Schlag (1998) ArticleTitleLocal excision of rectal cancer through windowed specula: long-term results Recent Result Cancer Res 146 114–123 Occurrence Handle1:STN:280:DyaK1czjsV2isw%3D%3D

    CAS  Google Scholar 

  22. CD Sutton L-J Marshall SA White N Flint DP Berry MJ Kelly (2002) ArticleTitleTen-year experience of endoscopic transanal resection Ann Surg 235 355–362 Occurrence Handle11882757 Occurrence Handle10.1097/00000658-200203000-00007

    Article  PubMed  Google Scholar 

  23. G Winde H Nottberg R Keller KW Schmid H Bunte (1996) ArticleTitleSurgical cure for early rectal carcinomas (T1): transanal endoscopic microsurgery vs. anterior resection Dis Colon Rectum 39 969–976 Occurrence Handle8797643 Occurrence Handle1:STN:280:BymA1M%2FmslQ%3D Occurrence Handle10.1007/BF02054683

    Article  PubMed  CAS  Google Scholar 

  24. PL Baron WE Enker ME Zakowski C Urmacher (1995) ArticleTitleImmediate vs. salvage resection after local treatment for early rectal cancer Dis Colon Rectum 38 177–181 Occurrence Handle7851173 Occurrence Handle1:STN:280:ByqC2Mvgs10%3D Occurrence Handle10.1007/BF02052447

    Article  PubMed  CAS  Google Scholar 

  25. J Faivre JC Chaume F Pigot M Trojani F Bonichon (1996) ArticleTitleTransanal electroresection of small rectal cancer: a sole treatment? Dis Colon Rectum 39 270–278 Occurrence Handle8603547 Occurrence Handle1:STN:280:BymC1cvkslM%3D Occurrence Handle10.1007/BF02049467

    Article  PubMed  CAS  Google Scholar 

  26. A Mellgren P Sirivong DA Rothenberger RD Madoff J Garcia-Aguilar (2000) ArticleTitleIs local excision adequate therapy or rectal cancer? Dis Colon Rectum 43 1064–1074 Occurrence Handle10950004 Occurrence Handle1:STN:280:DC%2BD3cvitVSgsA%3D%3D Occurrence Handle10.1007/BF02236551

    Article  PubMed  CAS  Google Scholar 

  27. CM Friel JW Cromwell C Marra RD Madoff DA Rothenberger J Garcia-Aguilar (2002) ArticleTitleSalvage radical surgery after failed local excision for early rectal cancer Dis Colon Rectum 45 875–879 Occurrence Handle12130873 Occurrence Handle10.1007/s10350-004-6320-z

    Article  PubMed  Google Scholar 

  28. JP Christie (1984) ArticleTitleMalignant colon polyps–cure by colonoscopy or colectomy? Am J Gastroenterol 79 543–547 Occurrence Handle6741907 Occurrence Handle1:STN:280:BiuB2MzmvVA%3D

    PubMed  CAS  Google Scholar 

  29. BC Morson JE Whiteway EA Jones FA Macrae CB Williams (1984) ArticleTitleHistopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy Gut 25 437–444 Occurrence Handle6714785 Occurrence Handle1:STN:280:DyaL2c7otlOlsg%3D%3D

    PubMed  CAS  Google Scholar 

  30. M Jung HJ Meier C Mennicken HO Barth BC Manegold (1988) ArticleTitleEndoscopic and surgical therapy of malignant colorectal polyps Z Gastroenterol 26 179–184 Occurrence Handle3407242 Occurrence Handle1:STN:280:BieA3cnksVQ%3D

    PubMed  CAS  Google Scholar 

  31. S Coverlizza M Risio A Ferrari CM Fenoglio-Preiser FP Rossini (1989) ArticleTitleColorectal adenomas containing invasive carcinoma. Pathologic assessment of lymph node metastatic potential Cancer 64 1937–1947 Occurrence Handle2477139 Occurrence Handle1:STN:280:By%2BD3c3nvFM%3D Occurrence Handle10.1002/1097-0142(19891101)64:9<1937::AID-CNCR2820640929>3.0.CO;2-X

    Article  PubMed  CAS  Google Scholar 

  32. K Sugihara T Muto Y Morioka (1989) ArticleTitleManagement of patients with invasive carcinoma removed by colonoscopic polypectomy Dis Colon Rectum 32 829–834 Occurrence Handle2791766 Occurrence Handle1:STN:280:By%2BD3cvnt10%3D

    PubMed  CAS  Google Scholar 

  33. T Muto T Sawada K Sugihara (1991) ArticleTitleTreatment of carcinoma in adenomas World J Surg 15 35–40 Occurrence Handle1994604 Occurrence Handle1:STN:280:By6C3srhsF0%3D Occurrence Handle10.1007/BF01658958

    Article  PubMed  CAS  Google Scholar 

  34. M Stolte P Hermanek (1990) Malignant polyps-pathological factors governing clinical management GT Williams (Eds) Gastrointestinal pathology, current topics in pathology Springer Berlin 277–293

    Google Scholar 

  35. P Hermanek (1991) ArticleTitlePrognosis of colorectal cancers Fortschr Med 109 187–188 Occurrence Handle2055583 Occurrence Handle1:STN:280:By6B2snksVQ%3D

    PubMed  CAS  Google Scholar 

  36. JT Brodsky GK Richard AM Cohen BD Minsky (1992) ArticleTitleVariables correlated with the risk of lymph node metastasis in early rectal cancer Cancer 69 322–326 Occurrence Handle1728363 Occurrence Handle1:STN:280:By2D1Mnps1U%3D Occurrence Handle10.1002/1097-0142(19920115)69:2<322::AID-CNCR2820690208>3.0.CO;2-B

    Article  PubMed  CAS  Google Scholar 

  37. LF Moreira H Iwagaki K Inoguchi A Hizuta K Sakagami K Orita (1992) ArticleTitleAssessment of lymph node metastasis and vessel invasion in early rectal cancer Acta Med Okayama 46 7–10 Occurrence Handle1561908 Occurrence Handle1:STN:280:By2B387nvFI%3D

    PubMed  CAS  Google Scholar 

  38. SP Huddy EM Husband MG Cook NM Gibbs CG Marks RJ Heald (1993) ArticleTitleLymph node metastases in early rectal cancer Br J Surg 80 1457–1458 Occurrence Handle8252364 Occurrence Handle1:STN:280:ByuD2szmslQ%3D

    PubMed  CAS  Google Scholar 

  39. S Kudo (1993) ArticleTitleEndoscopic mucosal resection of flat and depressed types of early colorectal cancer Endoscopy 25 455–461 Occurrence Handle8261988 Occurrence Handle1:STN:280:ByuD1crjtFE%3D

    PubMed  CAS  Google Scholar 

  40. A Hackelsberger P Fruhmorgen H Weiler T Heller H Seeliger K Junghanns (1995) ArticleTitleEndoscopic polypectomy and management of colorectal adenomas with invasive carcinoma Endoscopy 27 153–158 Occurrence Handle7601047 Occurrence Handle1:STN:280:ByqA38vks1w%3D Occurrence Handle10.1055/s-2007-1005654

    Article  PubMed  CAS  Google Scholar 

  41. K Hase CH Shatney H Mochizuki et al. (1995) ArticleTitleLong-term results of curative resection of “minimally invasive” colorectal cancer Dis Colon Rectum 38 19–26 Occurrence Handle7813339 Occurrence Handle1:STN:280:ByqC3M3mvVw%3D Occurrence Handle10.1007/BF02053852

    Article  PubMed  CAS  Google Scholar 

  42. R Kikuchi M Takano K Takagi et al. (1995) ArticleTitleManagement of early invasive colorectal cancer. Risk of recurrence and clinical guidelines Dis Colon Rectum 38 1286–1295 Occurrence Handle7497841 Occurrence Handle1:STN:280:BymC3c7lsF0%3D Occurrence Handle10.1007/BF02049154

    Article  PubMed  CAS  Google Scholar 

  43. S Tanaka K Haruma CR Teixeira et al. (1995) ArticleTitleEndoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis J Gastroenterol 30 710–717 Occurrence Handle8963387 Occurrence Handle1:STN:280:BymH3c7otVE%3D Occurrence Handle10.1007/BF02349636

    Article  PubMed  CAS  Google Scholar 

  44. T Masaki T Muto (2000) ArticleTitlePredictive value of histology at the invasive margin in the prognosis of early invasive colorectal carcinoma J Gastroenterol 35 195–200 Occurrence Handle10755688 Occurrence Handle1:STN:280:DC%2BD3c3hs1Cltg%3D%3D Occurrence Handle10.1007/s005350050330

    Article  PubMed  CAS  Google Scholar 

  45. S Nivatvongs (2000) ArticleTitleSurgical management of early colorectal cancer World J Surg 24 1052–1055 Occurrence Handle11036281 Occurrence Handle1:STN:280:DC%2BD3cvos12mtw%3D%3D Occurrence Handle10.1007/s002680010148

    Article  PubMed  CAS  Google Scholar 

  46. P Deinlein U Reulbach M Stolte M Vieth (2003) ArticleTitleRisk factors for lymphatic metastasis from pT1 colorectal adenocarcinoma Pathologe 24 387–393 Occurrence Handle12961027 Occurrence Handle1:STN:280:DC%2BD3svitFWisA%3D%3D Occurrence Handle10.1007/s00292-003-0632-y

    Article  PubMed  CAS  Google Scholar 

  47. TD Cecil R Sexton BJ Moran RJ Heald (2004) ArticleTitleTotal mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer Dis Colon Rectum 47 1145–1150 Occurrence Handle15164243 Occurrence Handle10.1007/s10350-004-0086-6

    Article  PubMed  Google Scholar 

  48. P Hermanek H Wiebelt D Staimmer S Riedl (1995) ArticleTitlePrognostic factors of rectum carcinoma-experience of the German Multicentre Study SGCRC. German Study Group Colo-Rectal Carcinoma Tumori 81 IssueIDSuppl 60–64 Occurrence Handle7571056 Occurrence Handle1:STN:280:BymD3MvgtVM%3D

    PubMed  CAS  Google Scholar 

  49. R Bleday E Breen JM Jessup A Burgess SM Sentovich GD Steel (1997) ArticleTitleProspective evaluation of local excision for small rectal cancers Dis Colon Rectum 40 388–392 Occurrence Handle9106685 Occurrence Handle1:STN:280:ByiB28%2Fls1E%3D Occurrence Handle10.1007/BF02258381

    Article  PubMed  CAS  Google Scholar 

  50. DM Ota J Skibber TA Rich (1992) ArticleTitleAnderson cancer centre experience with local excision and multimodality therapy for rectal cancer Surg Oncol Clin N Am 1 147–152

    Google Scholar 

To the Invited Commentary

  1. DL Beral JR Monson (2005) ArticleTitleIs local excision of T2/T3 rectal cancers adequate? Recent Results Cancer Res 165 120–135 Occurrence Handle15865027 Occurrence Handle1:STN:280:DC%2BD2M3jtVKjsg%3D%3D

    PubMed  CAS  Google Scholar 

  2. JT Brodsky GK Richard AM Cohen BD Minsky (1992) ArticleTitleVariables correlated with the risk of lymph node metastasis in early rectal cancer Cancer 69 322–326 Occurrence Handle1728363 Occurrence Handle1:STN:280:By2D1Mnps1U%3D Occurrence Handle10.1002/1097-0142(19920115)69:2<322::AID-CNCR2820690208>3.0.CO;2-B

    Article  PubMed  CAS  Google Scholar 

  3. D Blumberg PB Paty JG Guillem et al. (1999) ArticleTitleAll patients with small intramural rectal cancers are at risk for lymph node metastasis Dis Colon Rectum 42 881–885 Occurrence Handle10411434 Occurrence Handle1:STN:280:DyaK1Mzjslansw%3D%3D Occurrence Handle10.1007/BF02237095

    Article  PubMed  CAS  Google Scholar 

  4. A Mellgren P Sirivongs DA Rothenberger RD Madoff J Garcia-Aguilar (2000) ArticleTitleIs local excision adequate therapy for early rectal cancer? Dis Colon Rectum 43 1064–1074 Occurrence Handle10950004 Occurrence Handle1:STN:280:DC%2BD3cvitVSgsA%3D%3D Occurrence Handle10.1007/BF02236551

    Article  PubMed  CAS  Google Scholar 

  5. DA Rothenberger J Garcia-Aguilar (2000) ArticleTitleRole of local excision in the treatment of rectal cancer Semin Surg Oncol 19 367–375 Occurrence Handle11241919 Occurrence Handle1:STN:280:DC%2BD3MzitlCqug%3D%3D Occurrence Handle10.1002/ssu.7

    Article  PubMed  CAS  Google Scholar 

  6. S Sengupta JJ Tjandra (2001) ArticleTitleLocal excision of rectal cancer: what is the evidence? Dis Colon Rectum 44 1345–1361 Occurrence Handle11584215 Occurrence Handle1:STN:280:DC%2BD3MrjsFWmsw%3D%3D Occurrence Handle10.1007/BF02234796

    Article  PubMed  CAS  Google Scholar 

  7. A Mellgren J Goldberg DA Rothenberger (2005) ArticleTitleLocal excision: some reality testing Surg Clin North Am 14 183–196 Occurrence Handle10.1016/j.soc.2004.11.007

    Article  Google Scholar 

  8. KM Madbouly F Remzi BA Erkek et al. (2005) ArticleTitleRecurrence after transanal excision of T1 rectal cancer: should we be concerned? Dis Colon Rectum 48 711–721 Occurrence Handle15768186 Occurrence Handle10.1007/s10350-004-0666-0

    Article  PubMed  Google Scholar 

  9. CM Friel JW Cromwell C Marra RD Madoff DA Rothenberger J Garcia-Aguilar (2002) ArticleTitleSalvage radical surgery after failed local excision for early rectal cancer Dis Colon Rectum 45 875–879 Occurrence Handle12130873 Occurrence Handle10.1007/s10350-004-6320-z

    Article  PubMed  Google Scholar 

  10. PB Paty GM Nash P Baron et al. (2002) ArticleTitleLong-term results oflocal excision for rectal cancer Ann Surg 236 522–529 Occurrence Handle12368681 Occurrence Handle10.1097/00000658-200210000-00015

    Article  PubMed  Google Scholar 

  11. D Hahnloser BG Wolff DW Larson J Ping S Nivatvongs (2005) ArticleTitleImmediate radical resection after local excision of rectal cancer: an oncologic compromise? Dis Colon Rectum 48 429–437 Occurrence Handle15747069 Occurrence Handle10.1007/s10350-004-0900-9

    Article  PubMed  Google Scholar 

  12. MI Chorost NJ Petrelli M McKenna WG Kraybill MA Rodriguez-Bigas (2001) ArticleTitleLocal excision of rectal carcinoma Am Surg 67 774–779 Occurrence Handle11510582 Occurrence Handle1:STN:280:DC%2BD3Mvms1amsQ%3D%3D

    PubMed  CAS  Google Scholar 

  13. RH Taylor JH Hay SN Larsson (1998) ArticleTitleTransanal local excision of selected low rectal cancers Am J Surg 175 360–363 Occurrence Handle9600277 Occurrence Handle1:STN:280:DyaK1c3mtV2jtg%3D%3D Occurrence Handle10.1016/S0002-9610(98)00038-5

    Article  PubMed  CAS  Google Scholar 

  14. PB Paty (2005) ArticleTitleInvited editorial Dis Colon Rectum 48 719–721

    Google Scholar 

  15. GD Steele SuffixJr (2000) ArticleTitleInvited editorial Dis Colon Rectum 43 1064–1074 Occurrence Handle10.1007/BF02236552

    Article  Google Scholar 

  16. L Herrera-Ornelas J Justiniano N Castillo NJ Petrelli J Stulc A Mittleman (1987) ArticleTitleMetastases in small lymph nodes from colon cancer Arch Surg 122 1253–1256 Occurrence Handle3675188 Occurrence Handle1:STN:280:BieD2cfovFc%3D

    PubMed  CAS  Google Scholar 

  17. RJ Heald (1988) ArticleTitleThe ‘Holy Plane’ of rectal surgery J R Soc Med 81 503–508 Occurrence Handle3184105 Occurrence Handle1:STN:280:BiaD3sjgsVU%3D

    PubMed  CAS  Google Scholar 

  18. BD Minsky (1995) ArticleTitleConservative treatment of rectal cancer with local excision and postoperative radiation therapy Eur J Cancer 31A 1343–1346 Occurrence Handle7577048 Occurrence Handle1:STN:280:BymD2cnjsFE%3D Occurrence Handle10.1016/0959-8049(95)00157-E

    Article  PubMed  CAS  Google Scholar 

  19. JP Lamont TM McCarty RD Digan R Jacobson P Tulanon WE Lichliter (2000) ArticleTitleShould locally excised T1 rectal cancer receive adjuvant chemoradiation? Am J Surg 180 402–406 Occurrence Handle11182387 Occurrence Handle1:STN:280:DC%2BD3M7lvVWrtA%3D%3D Occurrence Handle10.1016/S0002-9610(00)00493-1

    Article  PubMed  CAS  Google Scholar 

  20. R Bleday E Breen JM Jessup A Burgess SM Sentovich G Steele SuffixJr (1997) ArticleTitleProspective evaluation of local excision for small rectal cancers Dis Colon Rectum 40 388–392 Occurrence Handle9106685 Occurrence Handle1:STN:280:ByiB28%2Fls1E%3D Occurrence Handle10.1007/BF02258381

    Article  PubMed  CAS  Google Scholar 

To the Authors Reply

  1. S Sengupta JJ Tjandra (2001) ArticleTitleLocal excision of rectal cancer: what is the evidence? Dis Colon Rectum 44 1345–1361 Occurrence Handle11584215 Occurrence Handle1:STN:280:DC%2BD3MrjsFWmsw%3D%3D Occurrence Handle10.1007/BF02234796

    Article  PubMed  CAS  Google Scholar 

  2. A Sharma J Hartley JR Monson (2003) ArticleTitleLocal excision of rectal tumours Surg Oncol 12 51–61 Occurrence Handle12689670 Occurrence Handle10.1016/S0960-7404(03)00007-0

    Article  PubMed  Google Scholar 

  3. PF Middleton LM Sutherland GJ Maddern (2005) ArticleTitleTransanal endoscopic microsurgery: a systematic review Dis Colon Rectum 48 270–284 Occurrence Handle15711865 Occurrence Handle10.1007/s10350-004-0804-8

    Article  PubMed  Google Scholar 

  4. G Winde H Nottberg R Keller KW Schmid H Bunte (1996) ArticleTitleSurgical cure for early rectal carcinomas (T1): transanal endoscopic microsurgery vs. anterior resection Dis Colon Rectum 39 969–976 Occurrence Handle8797643 Occurrence Handle1:STN:280:BymA1M%2FmslQ%3D Occurrence Handle10.1007/BF02054683

    Article  PubMed  CAS  Google Scholar 

  5. KM Madbouly FH Remzi BA Erkek et al. (2005) ArticleTitleRecurrence after transanal excision of T1 rectal cancer: should we be concerned? Dis Colon Rectum 48 711–721 Occurrence Handle15768186 Occurrence Handle10.1007/s10350-004-0666-0

    Article  PubMed  Google Scholar 

  6. DJ Bentrem S Okabe WD Wong et al. (2005) ArticleTitleT1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg 242 472–479 Occurrence Handle16192807

    PubMed  Google Scholar 

  7. P Hermanek FP Gall (1986) ArticleTitleEarly (microinvasive) colorectal carcinoma Int J Colorectal Dis 1 79–84 Occurrence Handle3611938 Occurrence Handle1:STN:280:BiiB1c3gt1w%3D Occurrence Handle10.1007/BF01648411

    Article  PubMed  CAS  Google Scholar 

  8. D Hahnloser BG Wolff DW Larson J Ping S Nivatvongs (2005) ArticleTitleImmediate radical resection after local excision of rectal cancer: an oncologic compromise? Dis Colon Rectum 48 429–437 Occurrence Handle15747069 Occurrence Handle10.1007/s10350-004-0900-9

    Article  PubMed  Google Scholar 

  9. ND Floyd TJ Saclarides (2005) ArticleTitleTransanal endoscopic microsurgical resection of pT1 rectal tumors Dis Colon Rectum 49 164–168 Occurrence Handle10.1007/s10350-005-0269-4

    Article  Google Scholar 

  10. BH Endreseth HE Myrvold P Romundstad UE Hestvik T Bjerkeset A Wibe InstitutionalAuthorNameThe Norwegian Rectal Cancer Group (2005) ArticleTitleTransanal excision vs. major surgery for T1 rectal cancer Dis Colon Rectum 48 1380–1388 Occurrence Handle15906120 Occurrence Handle10.1007/s10350-005-0044-6

    Article  PubMed  Google Scholar 

  11. D Gopaul P Belliveau T Vuong et al. (2004) ArticleTitleOutcome of local excision of rectal carcinoma Dis Colon Rectum 47 1780–1788 Occurrence Handle15622569 Occurrence Handle1:STN:280:DC%2BD2cnktlKhtQ%3D%3D Occurrence Handle10.1007/s10350-004-0678-9

    Article  PubMed  CAS  Google Scholar 

  12. DG Kim RD Madoff (1998) ArticleTitleTransanal treatment of rectal cancer: ablative methods and open resection Semin Surg Oncol 15 101–113 Occurrence Handle9730416 Occurrence Handle1:STN:280:DyaK1czpvVWrtg%3D%3D Occurrence Handle10.1002/(SICI)1098-2388(199809)15:2<101::AID-SSU7>3.0.CO;2-3

    Article  PubMed  CAS  Google Scholar 

  13. PL Baron WE Enker ME Zakowski C Urmacher (1995) ArticleTitleImmediate vs. salvage resection after local treatment for early rectal cancer Dis Colon Rectum 38 177–181 Occurrence Handle7851173 Occurrence Handle1:STN:280:ByqC2Mvgs10%3D Occurrence Handle10.1007/BF02052447

    Article  PubMed  CAS  Google Scholar 

  14. A Mellgren P Sirivong DA Rothenberg RD Madoff J Garcia-Aguilar (2000) ArticleTitleIs local excision adequate therapy or rectal cancer? Dis Colon Rectum 43 1064–1074 Occurrence Handle10950004 Occurrence Handle1:STN:280:DC%2BD3cvitVSgsA%3D%3D Occurrence Handle10.1007/BF02236551

    Article  PubMed  CAS  Google Scholar 

  15. CM Friel JW Cromwell C Marra RD Madoff DA Rothenberger J Garcia-Aguilar (2002) ArticleTitleSalvage radical surgery after failed local excision for early rectal cancer Dis Colon Rectum 45 875–879 Occurrence Handle12130873 Occurrence Handle10.1007/s10350-004-6320-z

    Article  PubMed  Google Scholar 

  16. MR Weiser RG Landmann WD Wong et al. (2005) ArticleTitleSurgical salvage of recurrent rectal cancer after transanal excision Dis Colon Rectum 48 1169–1175 Occurrence Handle15793645 Occurrence Handle10.1007/s10350-004-0930-3

    Article  PubMed  Google Scholar 

  17. S Bayar R Saxena B Emir RR Salem (2002) ArticleTitleVenous invasion may predict lymph node metastasis in early rectal cancer Eur J Surg Oncol 28 413–417 Occurrence Handle12099652 Occurrence Handle1:STN:280:DC%2BD38zlslSgtg%3D%3D Occurrence Handle10.1053/ejso.2002.1254

    Article  PubMed  CAS  Google Scholar 

  18. R Nascimbeni LJ Burgart S Nivatvongs DR Larson (2002) ArticleTitleRisk of lymph node metastasis in T1 carcinoma of the colon and rectum Dis Colon Rectum 45 200–206 Occurrence Handle11852333 Occurrence Handle10.1007/s10350-004-6147-7

    Article  PubMed  Google Scholar 

  19. WH Steup Y Moriya CJ Velde Particlevan de (2002) ArticleTitlePatterns of lymphatic spread in rectal cancer. A topographical analysis on lymph node metastases Eur J Cancer 38 911–918 Occurrence Handle11978516 Occurrence Handle1:STN:280:DC%2BD383ktVyrug%3D%3D Occurrence Handle10.1016/S0959-8049(02)00046-1

    Article  PubMed  CAS  Google Scholar 

  20. PJ Sitzler F Seow-Choen YH Ho AP Leong (1997) ArticleTitleLymph node involvement and tumor depth in rectal cancers: an analysis of 805 patients Dis Colon Rectum 40 1472–1476 Occurrence Handle9407987 Occurrence Handle1:STN:280:DyaK1c%2FmvFyktA%3D%3D Occurrence Handle10.1007/BF02070714

    Article  PubMed  CAS  Google Scholar 

  21. K Sugihara T Muto Y Morioka (1989) ArticleTitleManagement of patients with invasive carcinoma removed by colonoscopic polypectomy Dis Colon Rectum 32 829–834 Occurrence Handle2791766 Occurrence Handle1:STN:280:By%2BD3cvnt10%3D

    PubMed  CAS  Google Scholar 

  22. D Blumberg PB Paty JG Guillem et al. (1999) ArticleTitleAll patients with small intramural rectal cancers are at risk for lymph node metastasis Dis Colon Rectum 42 881–885 Occurrence Handle10411434 Occurrence Handle1:STN:280:DyaK1Mzjslansw%3D%3D Occurrence Handle10.1007/BF02237095

    Article  PubMed  CAS  Google Scholar 

  23. JT Brodsky GK Richard AM Cohen BD Minsky (1992) ArticleTitleVariables correlated with the risk of lymph node metastasis in early rectal cancer Cancer 69 322–326 Occurrence Handle1728363 Occurrence Handle1:STN:280:By2D1Mnps1U%3D Occurrence Handle10.1002/1097-0142(19920115)69:2<322::AID-CNCR2820690208>3.0.CO;2-B

    Article  PubMed  CAS  Google Scholar 

  24. HS Wang WY Liang TC Lin et al. (2005) ArticleTitleCurative resection of T1 colorectal carcinoma: risk of lymph node metastasis and long-term prognosis Dis Colon Rectum 48 1182–1192 Occurrence Handle15793641 Occurrence Handle10.1007/s10350-004-0935-y

    Article  PubMed  Google Scholar 

  25. SP Huddy EM Husband MG Cook NM Gibbs CG Marks RJ Heald (1993) ArticleTitleLymph node metastases in early rectal cancer Br J Surg 80 1457–1458 Occurrence Handle8252364 Occurrence Handle1:STN:280:ByuD2szmslQ%3D

    PubMed  CAS  Google Scholar 

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Acknowledgments

The authors thank Dr. J. Engel from the IBE Tumor Register Munich, Ludwig Maximilian University, Munich, Germany, for providing their data regarding long-term survival after conventional resection of pT1 rectal cancer.

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  1. Clinic of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Langenbeckstr. 1, Mainz, D-55131, Germany

    Thomas Borschitz M.D., Achim Heintz M.D. & Theodor Junginger M.D.

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  1. Thomas Borschitz M.D.
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  2. Achim Heintz M.D.
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  3. Theodor Junginger M.D.
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Correspondence to Theodor Junginger M.D..

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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 49, 1492–1506 (2006). https://doi.org/10.1007/s10350-006-0587-1

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