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Long-term Oncologic Outcome After Transanal Endoscopic Microsurgery for Rectal Carcinoma
Theodor Junginger1, Ursula Goenner, Mirjam Hitzler
11 Department of General and Abdominal Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany 2 Department of General, Visceral, and Vascular Surgery, Catholic Hospital Mainz, Mainz, Germany 3 Department of Heart, Chest, and Vascular Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany 4 Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany.
Background:
Transanal endoscopic microsurgery is superior to other methods of local excision of rectal cancer, but few studies report long-term follow-up data.
Objective:
This study investigated the use of transanal endoscopic microsurgery alone as curative and compromise therapy based on long-term disease recurrence and mortality.
Design:
This was a retrospective review of prospectively collected data.
Settings:
The study was conducted at a tertiary care university medical center.
Patients:
The study included 133 patients treated between 1985 and 2007. There were 3 groups, including transanal endoscopic microsurgery in curative intent (low-risk rectal carcinoma, including pT1, G1/2, L0, and LX with clear margins and a minimal distance between tumor and resection margin of >1 mm (N = 64) or clear margins only (N = 18 ))) and as compromise therapy (high-risk or incompletely resected rectal carcinoma; N = 51).
Main Outcome Measures:
Log-rank tests were used to compare overall and cancer-specific survival.
Results:
The median follow-up time was 8.6 years (range, 0.2-25.1 years), and a total of 131 of 133 patients (98.5%) were followed >5 years or until death. The preoperative diagnosis of carcinoma was not associated with belonging into 1 of the 3 categories. In patients with low-risk completely (>1 mm) resected carcinoma, the 5- and 10-year local recurrence rates were 6.6% and 11.6%. In patients with high-risk or incompletely resected carcinoma, the rates were 32.5% and 35.0% (p = 0.006). The 5- and 10-year cancer-specific survival rates for low-risk patients were 98.0% and 91.0% and 84.3% and 74.3% for high-risk patients (p = 0.05).
Limitations:
The study was limited by its retrospective design and small subgroups.
Conclusions:
The high cancer-specific survival justifies transanal endoscopic microsurgery alone as curative treatment in low-risk rectal carcinoma. Complete resection is essential to lower the risk of local recurrence. The high local recurrence rate in patients with high-risk rectal carcinoma restricts the use of TEM alone as compromise therapy.
