Citation: Colorectal Disease. 2019 Jun 17 [Epub ahead of print]
Author: Ondhia M, Tamvakeras P, O'Toole P, Montazerri A, Andrews T, Farrell C, Ahmed S, Slawik S, Ahmed S; Merseyside Early Rectal Cancer Network
Abstract: BACKGROUND: Organ-preserving local excision (LE) by transanal endoscopic microsurgery (TEM) for early rectal cancer offers significantly less morbidity with acceptable oncological outcomes. This study presents our 6-year experience of TEM for rectal lesions referred to a specialist early rectal cancer centre in the UK.
METHODS: Data were collected for all patients referred for Transanal Endoscopic Microsurgery (TEM) of suspected early rectal cancer at a regional Specialist Early Rectal Cancer MDT over a 6-year period.
RESULTS: 141 patients who underwent full thickness TEM for suspected or confirmed early rectal cancer were included. 30 patients were referred for TEM following incomplete endoscopic polypectomy. Final pathology was benign in 77 (54.6%) cases and malignant in 64 (45.4%). Of the 61 confirmed adenocarcinomas, TEM resections were pT0 in 17 (27.9%); 32 (51.7%) pT1; 11 (18.0%) pT2 and 1 (1.6%) pT3. 3861 (62.3%) had ≥1 poor histological prognostic feature and these patients were offered further treatment. 23/61 (37.7%) patients with rectal adenocarcinoma required no further treatment following TEM. 43 cases of rectal adenocarcinoma were available for establishing recurrence rates. 2/43 patients (4.7%) developed a recurrence in a median follow-up of 28.7 months (12.1-66.5 months). The overall estimated five-year overall survival rate was 87.9% and the disease-free survival rate was 82.9%.
CONCLUSION: Acceptable outcomes are possible for TEM surgery with appropriate patient selection, effective technique, expert histopathology, appropriate referral for adjuvant treatment and meticulous follow-up. This can be achieved through an early rectal cancer MDT in a dedicated specialist regional centre This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS: Early rectal cancer; Local excision rectal cancer
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