Does transanal local resection increase morbidity for subsequent total mesorectal excision for early rectal cancer?

AIM of this study was to improve treatment outcomes for early rectal cancer; to assess the accuracy of endorectal ultrasound (ERUS) in preoperative staging of early rectal cancer. MATERIAL AND METHODS. A total of 42 patients of the main prospective group with early rectal cancer underwent transanal local excision (LE). In control retrospective group 39 patients underwent radical resection with total mesorectal excision (TME). Operation time, perioperative, hospital stay duration long-term oncological results (overall and local recurrence-free survival, cancer-free survival, distant metastasis rate) were analyzed.. Comparison of ERUS preoperative staging for prospective group and pathological staging was performed to identify the accuracy of ERUS. RESULTS. Median follow-up for prospective group was 41 (from 10 to 60) months. In comparison with TME, LE was associated with fewer morbid (4,8 % vs 17,9 %, p=0,04). There was no hospital mortality in both groups. The accuracy of ERUS was 88,1 % for Tis and 78,6% for T1. There was no significant statistical difference in 1-year and 3-year in oncological outcomes between groups (p=1,0). There was one local recurrence (2,6%) in 6 months after LE in a patient with pT1sm3 who had previously refused surgery. This patient underwent TME. There was no detected distant metastasis in both groups. The 3-year overall survival was 100 % for LE and 97,4 % for TME. The 3-year cancer-specific survival was 100 % in both groups. CONCLUSIONS. LE has advantages over TME in short-term results; long-term oncological results after LE are comparable with TME. ERUS has a good diagnostic effectiveness in preoperative staging of early rectal cancer.

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Local Excision ± Chemoradiotherapy vs. Total Mesorectal Excision for Early Rectal Cancer: Case-Matched Analysis of Long-Term Results

Frontiers in Surgery ◽

10.3389/fsurg.2021.746784 ◽

2021 ◽

Vol 8 ◽

Author(s):

Julius Pacevicius ◽

Vidas Petrauskas ◽

Lukas Pilipavicius ◽

Audrius Dulskas

Keyword(s):

Rectal Cancer ◽

Postoperative Complications ◽

Total Mesorectal Excision ◽

Hospital Stay ◽

Local Excision ◽

Bowel Function ◽

Early Rectal Cancer ◽

Mesorectal Excision ◽

Oncological Outcomes

Background: Our aim was to compare the bowel function and oncologic outcomes following these two treatment modalities.Materials and methods: This was a single-center study with 67 patients included between 2009 and 2018. A total of 32 patients underwent total mesorectal excision (TME) group and 35 transanal local excisions (LE) ± chemoradiation. We performed a case-matched analysis: we matched the patients by age, cancer stage, and comorbidities. Duration of operation, postoperative complications, length of hospital stay, and long-term functional and oncological outcomes were compared. We calculated oncological outcomes using Kaplan–Meier Cox diagrams. In addition, we used a low anterior resection syndrome (LARS) score for the bowel function assessment.Results: Mean operation time in the LE group was 58.8 ± 45 min compared with the TME group that was 121.1 ± 42 min (p = 0.032). Complications were seen in 5.7% in LE group and 15.62% in TME group (p = 0.043). ~85.2% of the patients had no LARS in LE group compared with 54.5% in TME group (p = 0.018). Minor LARS was 7.4% in LE group compared with 31.8% in TME group (p = 0.018); major LARS was 7.4 and 13.7%, respectively (p = 0.474). Hospital stay was 2.77 days in LE group compared with 9.21 days in TME group (p = 0.036). The overall survival was 68.78 months in LE group compared with 74.81 months in TME group (p = 0.964).Conclusion: Our results of a small sample size showed that local excision ± chemoradiation is a rather safe method for early rectal cancer compared with gold standard treatment. In addition, better bowel function is preserved with less postoperative complications and shorter hospital stays.

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Nonoperative Management for T2 Low Rectal Cancer: A Western Approach

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0040-1714241 ◽

2020 ◽

Vol 33 (06) ◽

pp. 366-371

Author(s):

Laura Melina Fernandez ◽

Guilherme Pagin São Julião ◽

Bruna Borba Vailati ◽

Angelita Habr-Gama ◽

Rodrigo Oliva Perez

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Organ Preservation ◽

Complete Response ◽

Tumor Stage ◽

Neoadjuvant Chemoradiation ◽

Major Surgery ◽

Early Rectal Cancer ◽

Mesorectal Excision ◽

Early Tumor

AbstractThe possibility of organ preservation in early rectal cancer has gained popularity during recent years. Patients with early tumor stage and low risk for local recurrence do not usually require neoadjuvant chemoradiation for oncological reasons. However, these patients may be considered for chemoradiation exclusively for the purpose of achieving a complete clinical response and avoid total mesorectal excision. In addition, cT2 tumors may be more likely to develop complete response to neoadjuvant therapy and may constitute ideal candidates for organ-preserving strategies. In the setting where the use of chemoradiation is exclusively used to avoid major surgery, one should consider maximizing tumor response. In this article, we will focus on the rationale, indications, and outcomes of patients with early rectal cancer being treated by neoadjuvant chemoradiation to achieve organ preservation by avoiding total mesorectal excision.

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Quality of life after transanal endoscopic microsurgery and total mesorectal excision in early rectal cancer

Colorectal Disease ◽

10.1111/j.1463-1318.2006.01186.x ◽

2007 ◽

Vol 9 (6) ◽

pp. 553-558 ◽

Cited By ~ 61

Author(s):

P. G. Doornebosch ◽

R. A. E. M. Tollenaar ◽

M. P. Gosselink ◽

L. P. Stassen ◽

C. M. Dijkhuis ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Total Mesorectal Excision ◽

Transanal Endoscopic Microsurgery ◽

Early Rectal Cancer ◽

Mesorectal Excision ◽

Endoscopic Microsurgery

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Hybrid transanal and total mesorectal excision after transanal endoscopic microsurgery for unfavourable early rectal cancer: a report of two cases

Acta medica Lituanica ◽

10.6001/actamedica.v24i3.3553 ◽

2017 ◽

Vol 24 (3) ◽

pp. 188-192 ◽

Cited By ~ 1

Author(s):

Narimantas E. Samalavičius ◽

Audrius Dulskas ◽

Kęstutis Petrulis ◽

Alfredas Kilius ◽

Renatas Tikuišis ◽

...

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Transanal Endoscopic Microsurgery ◽

Low Rectal Cancer ◽

Early Rectal Cancer ◽

Mesorectal Excision ◽

Final Histology ◽

Complex Procedure ◽

Endoscopic Microsurgery

Completion total mesorectal excision (TME) is a rare but complex procedure after transanal endoscopic microsurgery for early rectal cancer with unfavourable final histology. Two cases are reported when completion TME was performed after upfront transanal partial mesorectal dissection. Intact non-perforated TME specimens with negative and adequate distal and circumferential margins were created. The quality of both total mesorectal excisions was complete and distal margins were sufficient. We believe that our technique might be a way of approaching completion TME after TEM, especially in cases of low rectal cancer.

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Circumferential margin involvement after total mesorectal excision for rectal cancer: Are patients all equals?

10.26226/morressier.578f37f9d462b8028d88f6da ◽

2016 ◽

Author(s):

Aurélie Beaufrère

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Circumferential Margin ◽

Mesorectal Excision ◽

Margin Involvement

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Wasmuth HH, Færden AE, Myklebust TÅ, et al (2020) Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 107:121–30

Côlon & Rectum ◽

10.3166/cer-2020-0146 ◽

2020 ◽

Vol 14 (3) ◽

pp. 155-158

Author(s):

M. Aubert ◽

Y. Panis

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Cancer Du Rectum ◽

Prise En Charge ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Récidive Locale ◽

Kaplan Meier ◽

Cancers Colorectaux ◽

Technique Chirurgicale

Contexte : L’exérèse totale du mésorectum par voie transanale (TaTME) pour la prise en charge du cancer du rectum est récemment apparue comme alternative à l’exérèse totale du mésorectum par voie abdominale. Cependant, certaines inquiétudes à propos des résultats oncologiques de cette technique chirurgicale ont émergé. Le but de cette étude était d’évaluer le taux de récidives locales après TaTME. Les objectifs secondaires s’intéressaient à la mortalité postopératoire, au taux de fistule anastomotique et au taux de stomie définitive. Méthodes : Les données de tous les patients opérés par TaTME ont été rapportées et comparées aux données issues des registres nationaux norvégiens de cancers colorectaux (NCCR) et de chirurgie gastro-intestinale (NoRGast). Les taux de récidive locale étaient estimés selon Kaplan-Meier. Résultats : En Norvège, 157 patients ont été opérés par TaTME pour un cancer du rectum entre octobre 2014 et octobre 2018. Trois des sept centres hospitaliers participants ont abandonné la réalisation de cette intervention après cinq procédures. Le taux de récidive locale était de 12 sur 157 patients (7,6 %) ; huit récidives locales étaient multifocales ou étendues. Le taux de récidive locale après un suivi de à 2,4 ans était estimé à 11,6 % (IC 95 % : [6,6‒19,9]) après TaTME contre 2,4 % (IC 95 % : [1,4‒4,4]) dans le registre NCCR (p < 0,001). Le hasard ratio était estimé à 6,71 (IC 95 % : [2,94‒15,32]). Le taux de fistule anastomotique nécessitant une réintervention était de 8,4 % dans le groupe TaTME contre 4,5 % dans le registre NoRGast (p = 0,047). Cinquante-six patients (35,7 %) étaient porteurs d’une stomie à la fin du suivi, dont 39 (24,8 %) étaient définitives. Conclusion : Le taux de fistule anastomotique était plus élevé après TaTME en comparaison aux données des registres nationaux norvégiens. Le taux de récidive locale ainsi que les caractéristiques de cette récidive après TaTME étaient défavorables.

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