Transanal Endoscopic Microsurgery for Early Rectal Cancer: A Single-Center Experience

Autor: Peter W. Callas, Jesse Moore, Conor H. O’Neill, Joseph Platz, Peter A. Cataldo
Rok vydání: 2017
Předmět:
Adult
Male
Transanal Endoscopic Microsurgery
medicine.medical_specialty
Colorectal cancer
medicine.medical_treatment
Rectum
Adenocarcinoma
Postoperative Hemorrhage
Single Center
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
medicine
Adjuvant therapy
Humans
Survival rate
Neoadjuvant therapy
Aged
Neoplasm Staging
Retrospective Studies
Aged
80 and over
Rectal Neoplasms
Urinary retention
business.industry
Gastroenterology
Margins of Excision
Chemoradiotherapy
Adjuvant
General Medicine
Length of Stay
Middle Aged
Urinary Retention
medicine.disease
Neoadjuvant Therapy
Surgery
Survival Rate
Treatment Outcome
medicine.anatomical_structure
030220 oncology & carcinogenesis
Female
030211 gastroenterology & hepatology
Neoplasm Recurrence
Local
medicine.symptom
business
Chemoradiotherapy
Zdroj: Diseases of the Colon & Rectum. 60:152-160
ISSN: 0012-3706
DOI: 10.1097/dcr.0000000000000764
Popis: Background There is debate regarding the appropriate use of transanal endoscopic microsurgery for rectal cancer. Objective This study analyzed our single-center experience with transanal endoscopic microsurgery for early rectal cancer. Design Medical charts of patients who underwent transanal endoscopic microsurgery were reviewed to determine lesion characteristics, as well as operative and treatment characteristics. Complications and recurrences were recorded. Settings The study was conducted at a single academic medical center. Patients Patients with early stage cancer (T1 or T2, N0, and M0) of the rectum were included. Main outcome measures Local and overall recurrence and disease-specific survival were measured. Results A total of 92 patients were analyzed. Median follow-up was 4.6 years. Negative margins were obtained in 98.9%. Length of stay was 1 day for 95.4% of patients. The complication rate was 10.9% (n = 10), including urinary retention at 4.3% (n = 4) and postoperative bleeding at 4.3% (n = 4). Preoperative staging included 54 at T1 (58.7%) and 38 at T2 (41.3%). Adjuvant therapy was recommended for all of the T2 and select T1 lesions with adverse features on histology. The final pathologic stages of tumors were ypT0 at 8.7% (n = 8), pT1 at 58.7% (n = 54), pT2 at 23.9% (n = 22), and ypT2 at 8.7% (n = 8). The 3-year local recurrence risk was 2.4% (SE = 1.7), and overall recurrence was 6.7% (SE = 2.9). There were no recurrences among patients with complete pathologic response to neoadjuvant therapy. Mean time to recurrence was 2.5 years (SD = 1.43). A total of 89.2% of patients with very low tumors underwent curative resection without a permanent stoma (33/37). The 3-year disease-specific survival rate was 98.6% (95% CI, 90.4%-99.8%), and overall survival rate was 89.4% (95% CI, 79.9%-94.6%). Limitations The study was limited by its single-center retrospective experience. Conclusions Transanal endoscopic microsurgery provides comparable oncologic outcomes to radical resection in properly selected patients with early rectal cancer. Sphincter preservation rates approach 90% even in patients with very distal rectal cancer.
Databáze: OpenAIRE
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