Transanal endoscopic microsurgical resection of pT1 rectal tumors

PURPOSE: Transanal endoscopic microsurgery has emerged as an improved method of transanal excision of neoplasms because its enhanced visibility, superior optics, and longer reach permit a more complete excision and precise closure. This study will show that transanal endoscopic microsurgical treatment of pT1 rectal cancers is safe and achieves low local recurrence and high survival rates. METHODS: Retrospective review performed of all pT1 rectal cancers treated by a single surgeon (TS) using transanal endoscopic microsurgery between 1991 and 2003. Patient age, gender, tumor distance from the anal verge, lesion size, operative time, blood loss, complications, recurrence, and survival rates were prospectively recorded. RESULTS: Fifty- three patients (average age, 65.6 (range, 31 - 89) years) were studied. Forty- nine percent were male. Average tumor distance from the anal verge was 7 (range, 0 - 13) cm; average size was 2.4 (range, 1 - 10) cm. Radiation and/ or chemotherapy were not administered. Sixteen patients had pT1 lesions removed piecemeal during colonoscopy; there was no residual tumor after transanal endoscopic microsurgical resection of the polyp site. Mean follow- up was 2.84 years. Fifty- one percent had longer than two- year follow- up. For the entire group, there were four recurrences (7.5 percent) occurring at 9 months, 15 months, 16 months, and 11 years. Two were treated with abdominoperineal resection, one with low anterior resection, and one with fulguration alone. There were no recurrences in the 16 patients who had excision of the polypectomy site. If excluded, recurrence was 11 percent (4/ 37). Patients were examined at three- month intervals for the first two years and every six months thereafter. There have been no cancer- related deaths. CONCLUSIONS: Transanal endoscopic microsurgical resection of pT1 rectal cancers yields low recurrence rates. Close follow- up permits curative salvage for those that do recur. Transanal excision remains a viable option.