Risk Factors for Recurrence After Transanal Endoscopic Microsurgery for Rectal Malignant Neoplasm

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2011 Jun 8

PMID 21647814

Citations 40

Authors

Mario Morino

Marco Ettore Allaix

Mario Caldart

Gitana Scozzari

Alberto Arezzo

Affiliations

Soon will be listed here.

Abstract

Background: Indications and results of local excision of rectal lesions are currently under debate. Transanal endoscopic microsurgery (TEM), allowing a precise, full-thickness excision, could improve oncological results in early rectal tumors.

Methods: A prospective database was analyzed with the intent to identify risk factors for recurrence after TEM.

Results: Among 355 patients subjected to TEM, 107 had an adenocarcinoma: 48 pT1, 43 pT2, and 16 pT3. Comparing pre- and postoperative data, histological discrepancy was 20% and staging discrepancy was 34%. Mortality was nil, morbidity was 9%. Mean follow-up was 54.2 months (range = 12-164), follow-up rate was 100%. The 5-year disease-free survival rate was 85.9, 78.4, and 49.4% for pT1, pT2, and pT3, respectively (p = 0.006). Recurrence rate was 0% (0/26) in pT1sm1 cancers and 22.7% (5/22) in sm2-3 (p < 0.05). A submucosal infiltration represented a significant risk factor for recurrences: 0% sm1, 16.7% sm2, and 30% sm3. Recurrence in pT2 was 0% in patients who had neoadjuvant therapy and 26% in the others. At univariate analysis, diameter, sm stage, pT stage, tumor grading, margin infiltration, and lymphovascular invasion demonstrated statistical significance. Multivariate analysis indicated sm stage, pT stage, and tumor grading as independent predictors of recurrence.

Conclusions: TEM represents an effective curative treatment for pT1 sm1 rectal malignancies. pT1 sm2-3 patients should be considered high-risk cases if treated only by TEM. A consistent improvement in the preoperative assessment of the risk factors identified by the present study will be a crucial development for optimal treatment of early rectal cancers.

Citing Articles

Geriatric Approaches to Rectal Cancer: Moving Towards a Patient-Tailored Treatment Era.

Vallicelli C, Barbara S, Fabbri E, Perrina D, Griggio G, Agnoletti V J Clin Med. 2025; 14(4).

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Efficacy and safety of transanal endoscopic microsurgery for early rectal cancer: a meta-analysis.

Wang C, Huang T, Wang X Front Oncol. 2025; 15:1545547.

PMID: 39995839 PMC: 11847824. DOI: 10.3389/fonc.2025.1545547.

Local Recurrence of Premalignant and Early Malignant Rectal Polyps Treated by TEM-A Single-Center Experience.

Khalifa M, Gingold-Belfer R, Issa N J Clin Med. 2025; 14(1.

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Local excision for middle-low rectal cancer after neoadjuvant chemoradiation: A retrospective study from a single tertiary center.

Chen N, Li C, Wang L, Yao Y, Peng Y, Zhan T World J Gastrointest Oncol. 2024; 16(12):4614-4624.

PMID: 39678786 PMC: 11577377. DOI: 10.4251/wjgo.v16.i12.4614.

Risk Factors for Rectal Cancer Recurrence after Local Excision of T1 Lesions from a Decade-Long Multicenter Retrospective Study.

Rudnicki Y, Goldberg N, Horesh N, Harbi A, Lubianiker B, Green E J Clin Med. 2024; 13(14).

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