The value of endorectal ultrasonography in the follow-up of intracavitary radiation treated early rectal cancer

Background / objectiveTo evaluate the initial experience with transanal endoscopic microsurgery (TEM) for early rectal cancer in a single center.Patients and methodsFrom February 2010 to October 2012 a total of 16 patients underwent TEM for early rectal cancer. 7 were women and 9 men, age range 52 to 88 years (median – 71 years). Postoperative surveillance protocol, which includes rigid proctoscopy, CEA and endorectal ultrasound every 3 months during first two years, was applied to all patients after TEM.ResultsFinal histology revealed 10 (62.5% ) lesions to be T1 and 6 (37.5%) T2 cancers. There were no postoperative complications. All 6 patients in pT2 group and those in pT1 group with unfavorable histology were offered adjuvant chemoradiotherapy or immediate radical surgery. Patients were followed up from 1 to 27 months (median – 14 months). There was one local recurrence (6.25%) in a patient who refused to undergo abdominoperineal excision for T1 low rectal cancer, had unfavorable histology after TEM, 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.ConclusionsIn our hands, TEM was an alternative to standard 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.Key words: early rectal cancer, transanal endoscopic microsurgery, recurrence, survival.Transanalinė endoskopinė mikrochirurgija anktyvam tiesiosios žarnos vėžiui gydyti Ligoniai ir metodaiNuo 2010 m. vasario iki 2012 m. spalio 16 pacientų, sergančių ankstyvuoju tiesiosios žarnos vėžiu, buvo gydyti TEM būdu (7 vyrai ir 9 moterys, amžius – nuo 52 iki 88 metų; mediana – 71 metai). Visiems pacientams buvo atliekama pooperacinėstebėsena: proktoskopija, endorektalinė sonoskopija ir CEA tyrimas kas 3 mėn. pirmus dvejus metus.RezultataiHistologinio tyrimo metu rasta 10 (62,5 %) T1 navikų ir 6 (37,5 %) T2 navikai. Artimųjų pooperacinių komplikacijų nebuvo. Visiems šešiems pT2 grupės pacientams ir pT1 didelės rizikos pacientams buvo pasiūlyta adjuvantinė chemoradioterapijaar skubus radikalus operacinis gydymas. Pacientai buvo stebimi nuo 1 iki 27 mėn. (mediana –14 mėn.). Vienam pacientui (6,25 %), atsisakiusiam abdominoperinealinės rezekcijos del žemo didelės rizikos T1 naviko, po chemospindulinio gydymonavikas atsinaujino. Po 7 mėn. šiam pacientui buvo atlikta abdominoperinealinė rezekcija (rpT2N0M0). Vienas pacientas pasitikrinti neatvyko. Kiti pacientai yra gyvi, jiems nėra recidyvo.IšvadosTEM yra alternatyvus gydymo metodas tradicinei totalinei mezorektalinei ekscizijai (TME) pacientams, sergantiems mažos rizikos tiesiosios žarnos vėžiu. Tolesnė stebėsena reikalinga siekiant įvertinti recidyvų dažnį ir išgyvenamumą po TEM esantinvazyviam tiesiosios žarnos vėžiui.Reikšminiai žodžiai: ankstyvas tiesiosios žarnos vėžys, gydymas, transanalinė endoskopinė mikrochirurgija.

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Endorectal ultrasonography in the follow-up of rectal cancer

International Journal of Colorectal Disease ◽

10.1007/s003840050085 ◽

1997 ◽

Vol 12 (2) ◽

pp. 78-81 ◽

Cited By ~ 32

Author(s):

F. Novell ◽

S. Pascual ◽

P. Viella ◽

M. Trias

Keyword(s):

Rectal Cancer ◽

Endorectal Ultrasonography

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Endoscopic full-thickness resection for T1 early rectal cancer: a case series and video report

Endoscopy International Open ◽

10.1055/s-0043-118657 ◽

2017 ◽

Vol 05 (11) ◽

pp. E1081-E1086 ◽

Cited By ~ 10

Author(s):

Paola Soriani ◽

Gian Tontini ◽

Helmut Neumann ◽

Germana de Nucci ◽

Domenico De Toma ◽

...

Keyword(s):

Rectal Cancer ◽

Endoscopic Resection ◽

Surgical Approach ◽

Case Series ◽

Disease Recurrence ◽

Colorectal Polyps ◽

Early Rectal Cancer ◽

Full Thickness ◽

En Bloc

Abstract Background and study aims Endoscopic treatment of malignant colorectal polyps is often challenging, especially for early rectal cancer (ERC) localized close to the dentate line. Conversely, the surgical approach may result in temporary or definitive stoma and in frequent post-surgical complications. The Full-Thickness Resection Device (FTRD®) System (Ovesco Endoscopy, Tübingen, Germany) is a novel system that, besides having other indications, appears to be promising for wall-thickness excision of intestinal T1 carcinoma following incomplete endoscopic resection. However, follow-up data on patients treated with this device are scarce, particularly for ERC. Patients and methods Six consecutive patients with incomplete endoscopic resection of T1-ERC were treated with the FTRD and their long-term outcomes were evaluated based on a detailed clinical and instrumental assessment. Results The endoscopic en bloc full-thickness resection was technically feasible in all patients. The histopathologic analysis showed a complete endoscopic resection in all cases, and a full-thickness excision in four. Neither complications, nor disease recurrence were observed during the 1-year follow-up period. Conclusions The FTRD System is a promising tool for treating ERC featuring a residual risk of disease recurrence after incomplete endoscopic mucosal resection in patients unfit for surgery or refusing a surgical approach.

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Rectal Polyps and Early Rectal Cancer Assessment by Three-Dimensional Endorectal Ultrasonography

Intestinal Polyps and Polyposis ◽

10.1007/978-88-470-1124-3_9 ◽

2009 ◽

pp. 103-113

Author(s):

Guilio Aniello Santoro ◽

Sandro Magrini ◽

Luciano Pellegrini ◽

Guiseppe Gizzi ◽

Guiseppe Di Falco

Keyword(s):

Rectal Cancer ◽

Three Dimensional ◽

Early Rectal Cancer ◽

Endorectal Ultrasonography ◽

Rectal Polyps

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Combined endorectal ultrasonography and strain elastography for the staging of early rectal cancer

Colorectal Disease ◽

10.1111/codi.12764 ◽

2014 ◽

Vol 17 (1) ◽

pp. 50-56 ◽

Cited By ~ 15

Author(s):

J. E. R. Waage ◽

S. P. Bach ◽

F. Pfeffer ◽

S. Leh ◽

R. F. Havre ◽

...

Keyword(s):

Rectal Cancer ◽

Early Rectal Cancer ◽

Endorectal Ultrasonography ◽

Strain Elastography

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Long term analysis of recurrences in patients treated by multimodality approach for local treatment of early rectal cancer—Liverpool’s Experience

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.18539 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 18539-18539 ◽

Cited By ~ 1

Author(s):

A. Sun Myint ◽

F. Elam ◽

A. McDonald ◽

M. J. Hershman

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Salvage Surgery ◽

Local Treatment ◽

Early Rectal Cancer ◽

Radical Radiotherapy ◽

Mortality And Morbidity ◽

Multimodality Approach

18539 Background: Local treatment of early rectal cancer with curative intent is highly controversial. Three years ago, we reported our results in 100 patients treated by multimodality approach. We have updated our results and analyse the pattern of recurrences in155 patients treated up to 2005 Methods: From Jan 1992 to Jan 2005, local treatment was offered to 155 patients with low rectal carcinoma. The majority of patients were elderly with the mean age of 76 years( range 33–101). There were 87 males and 68 females. 109 had surgery; TEM (79 patients) and TAR(30 patients). Forty six patients had radical radiotherapy alone.Locally treated patients were followed up regularly with DRE and sigmoidoscopy. CT and MRI scans were done at 0,12 and 24 months. Results: Local recurrence only occured in 13 patients (8.3%). Four patients had local and distant recurrence (2.5%). Overall local recurrence occured in 17 patients (10.8 %). Salvage surgery was carried out in 11 patients(10 APER and 1 local excision). Two had retreatment with Papillon. A total of 13 patients had salvage treatments (76.5%). At median follow-up of 40 months (range 12–168) only 72.7% of patients were still alive. Five patients (3.2%) developed distant metastases only and one had nodal recurrence. Cancer specific survival was 96% and colostomy free survival was 93%. Conclusions: Local treatment of early rectal cancer is a complex issue that needs to be address and discuss. As ageing populationis likely to increased in the next decade demands on local treatment will increase. It is important to balance the benefits of radical surgery in terms of lower local recurrence against increase mortality and morbidity from such procedures especially in elderly patients, versus slightly higher local recurrences and much lower mortality and morbidity from conservative treatments such as TEM and Papillon contact radical radiotherapy. Our study has shown that local treatment is safe and effective treatment for elderly patients with medical co morbidity. In our experience, salvage surgery can be offered for recurrences in the majority of patients but long term close follow-up is necessary. A careful case selection and multimodality treatment is essential for successful out come. No significant financial relationships to disclose.

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Faculty Opinions recommendation of Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.4349957.4173055 ◽

2010 ◽

Author(s):

Heidi K Chua

Keyword(s):

Rectal Cancer ◽

Transanal Endoscopic Microsurgery ◽

Transanal Excision ◽

Early Rectal Cancer ◽

Endoscopic Microsurgery

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The Ferguson Operating Anoscope for Resection of T1 Rectal Cancer

The American Surgeon ◽

10.1177/000313481608201127 ◽

2016 ◽

Vol 82 (11) ◽

pp. 1105-1108

Author(s):

Kristin C. Turza ◽

Thomas Brien ◽

Steven Porbunderwala ◽

Christopher M. Bell ◽

Shauna Lorenzo-rivero ◽

...

Keyword(s):

Rectal Cancer ◽

Anal Verge ◽

Tertiary Care ◽

Primary Lung Cancer ◽

Disease Free Survival ◽

Rectal Tumors ◽

Salvage Operation ◽

T1 Rectal Cancer

The Ferguson Operating Anoscope (FOA) is a surgical instrument, which can facilitate transanal excision of appropriate rectal tumors within 15 cm of the anal verge. Previous work showed low recurrence (4.3%) for favorable T1 tumors (no lymphovascular invasion, well/moderate differentiation, negative margins). This follow-up study evaluates outcomes in rectal cancer excised with FOA at a tertiary care center. T1 rectal cancer patients were identified in a prospectively maintained database. Tumor pathology and patient characteristics were reviewed. Primary outcomes include tumor recurrence and patient and disease-free survival. Secondary outcomes are quality of excision (intact specimen). Twenty-eight patients had pathologic stage T1 rectal cancer (average 8 ± 2.6 cm from the anal verge). Final path demonstrated 14 per cent to be well differentiated, 82 per cent moderately differentiated, and 93 per cent without angiolymphatic invasion. All specimens removed were intact. One patient had a true local recurrence and underwent a salvage operation 24 months after her index operation. Patient survival was 96.4 per cent (n = one death from primary lung cancer) at median follow-up 64 ± 35 months. With appropriate tumor selection and quality of initial resection, FOA has demonstrated utility in achieving optimal oncologic resection of T1 rectal tumors.

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