Transanal endoscopic microsurgery for early rectal cancer: single center experience

Narimantas Samalavicius; Marijus Ambrazevicius; Alfredas Kilius; Kestutis Petrulis

doi:10.5114/wiitm.2014.44138

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abstract:

Original paper

Transanal endoscopic microsurgery for early rectal cancer: single center experience

Narimantas Samalavicius

,

Marijus Ambrazevicius

,

Alfredas Kilius

,

Kestutis Petrulis

Videosurgery Miniinv 2014; 9 (4): 603–607

DOI: https://doi.org/10.5114/wiitm.2014.44138

Online publish date: 2014/07/19

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Introduction: The use of transanal endoscopic microsurgery (TEM) is increasing due to the ability to perform minimally invasive local treatment with large full-thickness local excision under improved vision.

Aim: To evaluate the initial experience with TEM for early rectal cancer in a single center.

Material and methods: From February 2010 to November 2013 a total of 20 patients underwent TEM for early rectal cancer. Nine were women and 11 men, age range 39 to 88 years (median: 71 years). The postoperative surveillance protocol, which includes rigid proctoscopy, carcinoembryonic antigen (CEA) and endorectal ultrasound every 3 months during the first 2 years, was applied to all patients after TEM.

Results: Final histology revealed 14 (70%) lesions to be T1 and 6 (30%) T2 cancers. There were no postoperative complications. All 6 patients in the pT2 group and those in the pT1 group with unfavorable histology were offered adjuvant chemoradiotherapy or immediate radical surgery. Patients were followed up from 2 to 35 months (median: 21 months). There was one local recurrence (5%) in a patient who refused to undergo abdominoperineal excision for T1 low rectal cancer, had unfavorable histology after TEM, and for which reason underwent postoperative chemoradiation. The patient had abdominoperineal resection 7 months after TEM (rpT2N0M0). One patient was lost to follow-up. The rest of the patients are alive and disease-free.

Conclusions: In our hands, TEM was an alternative to total mesorectal excision in patients with low-risk early rectal cancer. Further follow-up is necessary to evaluate recurrence and survival rates after TEM for patients with invasive rectal cancer.

keywords:

Transanal endoscopic microsurgery for early rectal cancer: single center experience

Narimantas Samalavicius , Marijus Ambrazevicius , Alfredas Kilius , Kestutis Petrulis

transanal endoscopic microsurgery, early rectal cancer, recurrence, survival

Narimantas Samalavicius

,

Marijus Ambrazevicius

,

Alfredas Kilius

,

Kestutis Petrulis