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

De Graaf, E.J.R.; Doornebosch, P.G.; Tollenaar, R.A.E.M.; Meershoek-Klein Kranenbarg, E.; de Boer, A.C.; Bekkering, F.C.; van de Velde, C.J.H.

doi:10.1016/j.ejso.2009.05.001

« Previous Next »European Journal of Surgical Oncology
Volume 35, Issue 12 , Pages 1280-1285, December 2009

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

E.J.R. De Graaf
- Department of General Surgery, IJsselland Hospital, P.O. Box 690, 2900 AR, Capelle aan den IJssel, The Netherlands
- Corresponding author. Tel.: +31 10 2585066; fax: +31 10 2585064.
P.G. Doornebosch
- Department of General Surgery, IJsselland Hospital, P.O. Box 690, 2900 AR, Capelle aan den IJssel, The Netherlands
R.A.E.M. Tollenaar
- Department of General Surgery, Leiden University Medical Centre, Leiden, The Netherlands
E. Meershoek-Klein Kranenbarg
- Department of General Surgery, Leiden University Medical Centre, Leiden, The Netherlands
A.C. de Boer
- Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
F.C. Bekkering
- Department of Gastroenterology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
C.J.H. van de Velde
- Department of General Surgery, Leiden University Medical Centre, Leiden, The Netherlands

Accepted 6 May 2009.

Abstract

Purpose

After total mesorectal excision (TME) for rectal cancer, pathology is standardized with margin status as a predictor for recurrence. This has yet to be implemented after transanal endoscopic microsurgery (TEM) and was investigated prospectively for T1 rectal adenocarcinomas.

Patients and methods

Eighty patients after TEM were compared to 75 patients after TME. The study protocol included standardized pathology. TEM patients were eligible when excision margins were negative.

Results

TEM was safer than TME as reflected by operating time, blood loss, hospital stay, morbidity, re-operation rate and stoma formation (all P<0.001). Mortality after TEM was 0% and after TME 4%. At 5 years after TEM and TME, both overall survival (TEM 75% versus TME 77%, P=0.9) and cancer-specific survival (TEM 90% versus TME 87%, P=0.5) were comparable. Local recurrence rate after TEM was 24% and after TME 0% (HR 79.266, 95% CI, 1.208 to 5202, P<0.0001).

Conclusion

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.

Keywords: T1 rectal cancer, Transanal endoscopic microsurgery, Total mesorectal excision, TEM, TME, Survival