Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention

Abstract

For T1 rectal adenocarcinomas TEM is much saver than TME and survival is comparable. After TEM local recurrence rate is substantial, despite negative excision margins.

Transanal endoscopic microsurgery: a review

“…Similarly the other 3 studies reported no difference in 5-year cancer-free and overall survival rates. De Graaf and colleagues 24 reported a significantly lower local recurrence rate in the radical resection group (24% in the TEM group v. 0% in the TME group, p < 0.001). Positive margin rates were shown to be higher with TEM than radical resection by Palma and colleagues 100 and Heintz and colleagues; 101 however, they observed similar local recurrence rates in both the TEM and radical resection groups.…”

“…22,24,100,101 Only 1 was a prospective randomized study. In this study, Winde and colleagues 22 found no difference in oncologic outcomes between the treatment groups.…”

A phase I/II study of neoadjuvant chemotherapy with Pemetrexed (Alimta) in rectal cancer

“…The reports of even complete responders, rendering surgery unnecessary or at least limiting the extent of the surgical procedure, could challenge the neoadjuvant strategies to further refinement. Limited surgical approach such as TEM (Transanal Endoscopic Microsurgery) can be an option for selected patients with small and early tumours which have favourable characteristics [5,6]. Neoadjuvant treatment has then been used in this setting to improve local control [7].…”

Completion proctectomy following transanal endoscopic microsurgery for early rectal cancer

“…In terms of oncological results, local excision of early rectal cancer (pT1) by TEM has equivalent outcomes to radical resection [10,11,13,14] . Due to abovementioned advantageous attributes, the use of TEM for early rectal cancer is now considered a viable option in selected patients, and may be offered to patents with lesions pre-operatively staged as T1N0, with tumor diameter < 4 cm involving less than 30% of the rectal wall circumference, and no histological risk factors [16][17][18][19][20] .…”

“…TEM has proven to be a safe and effective procedure in removal of rectal lesions [2][3][4][5][6][7][8][9] . TEM has furthermore considerably lower morbidity and mortality compared with conventional radical rectal resection for rectal tumors [10][11][12][13][14][15] . For patients with tumors in the lower part of the rectum, local excision by TEM may offer a chance for preserved bowel continuity and avoidance of rectal amputation with subsequent consequences.…”