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Updated: Mar 19, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
National Early Rectal Cancer Treatment Revisited
Tore Stornes1, Arne Wibe, Arild Nesbakken
11 Department of Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway 2 Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway 3 Institute of Clinical Medicine, University of Oslo, Oslo, Norway 4 Department of Gastrointestinal Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway 5 Centre for Cancer Biomedicine, Faculty of Medicine, University of Oslo, Oslo, Norway 6 K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norway 7 Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
Background:
Treatment of early stage rectal cancer has excellent oncological results. To reduce treatment-related mortality and morbidity and improve functional results, a focus on local resections is increasingly important.
Objective:
The purpose of this study was to compare outcomes after transanal endoscopic microsurgery and total mesorectal excision for early stage rectal cancer (T1 + T2) in Norway.
Design:
This was an observational study based on prospective data from the Norwegian Colorectal Cancer Registry.
Settings:
The study was conducted as a national, population-based study.
Patients:
All 543 patients with T1 and 1593 patients with T2 rectal cancer without distant metastases that was treated by transanal endoscopic microsurgery or total mesorectal excision without radiochemotherapy during 2000-2009 were included.
Main Outcome Measures:
The primary outcomes were 5-year relative survival and 5-year local recurrence rate.
Results:
Among 543 patients with T1 cancer, the 5-year overall survival rate was 65.3% after transanal endoscopic microsurgery versus 81.5% after total mesorectal excision (p = 0.012). Adjusted for age and sex there was no excess mortality for transanal endoscopic microsurgery (HR = 1.28 (95% CI, 0.8-1.9); p = 0.22). The 5-year relative survival rate was 96.8% after transanal endoscopic microsurgery versus 98.2% after total mesorectal excision (p = 0.603), and the 5-year local recurrence rate was 14.5% versus 1.4% (p < 0.001). Among 1593 patients with T2 cancer, 5-year overall survival was 42.1% versus 76.1% (p < 0.001), 5-year relative survival was 65.4% versus 93.9% (p < 0.001), and 5 year local recurrence rate was 11.4% versus 4.4% in the 2 groups.
Limitations:
The study is limited by its observational design and that the 2 groups were different according to patient and tumor characteristics. Another limitation was the low number of transanal endoscopic microsurgery procedures.
Conclusions:
Transanal endoscopic microsurgery had comparable 5-year relative survival to total mesorectal excision in T1 rectal cancer but inferior 5-year relative survival in T2 rectal cancer. Transanal endoscopic microsurgery was associated with higher local recurrence rates for both T1 and T2 tumors.
