Transanal Endoscopic Microsurgery for Rectal Lesions in a Specialist Regional Early Rectal Cancer Centre: the Mersey Experience

Overview

Journal Colorectal Dis

Specialty Gastroenterology

Date 2019 Jun 18

PMID 31207005

Citations 4

Authors

M Ondhia

P Tamvakeras

P OToole

A Montazerri

T Andrews

C Farrell

S Slawik

S Ahmed

Affiliations

Soon will be listed here.

Abstract

Aim: Organ-preserving local excision by transanal endoscopic microsurgery (TEM) for early rectal cancer offers significantly lower morbidity as compared to formal rectal cancer resection with acceptable outcomes. This study presents our 6-year experience of TEM for rectal lesions referred to a specialist early rectal cancer centre in the UK.

Method: Data were collected for all patients referred for TEM of suspected early rectal cancer to a regional specialist early rectal cancer multidisciplinary team (MDT) over a 6-year period.

Results: One hundred and forty-one patients who underwent full-thickness TEM for suspected or confirmed early rectal cancer were included. Thirty patients were referred for TEM following incomplete endoscopic polypectomy. Final pathology was benign in 77 (54.6%) cases and malignant in 64 (45.4%). Of the 61 confirmed adenocarcinomas, TEM resections were pT0 in 17 (27.9%), pT1 in 32 (51.7%), pT2 in 11 (18.0%) and pT3 in 1 (1.6%). Thirty-eight of 61 patients (62.3%) had one or more poor histological prognostic features and these patients were offered further treatment. Twenty-three of 61 (37.7%) patients with rectal adenocarcinoma required no further treatment following TEM. Forty-three cases of rectal adenocarcinoma were available for establishing recurrence rates. Two of 43 patients (4.7%) developed a recurrence at a median follow-up of 28.7 months (12.1-66.5 months). The overall estimated 5-year overall survival rate was 87.9% and the disease-free survival rate was 82.9%.

Conclusion: Acceptable outcomes are possible for TEM surgery with appropriate patient selection, effective technique, expert histopathology, appropriate referral for adjuvant treatment and meticulous follow-up. This can be achieved through an early rectal cancer MDT in a dedicated specialist regional centre.

Citing Articles

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.

Prognosis of Patients Over 60 Years Old With Early Rectal Cancer Undergoing Transanal Endoscopic Microsurgery - A Single-Center Experience.

Zhang M, Zhang Y, Jing H, Zhao L, Xu M, Xu H Front Oncol. 2022; 12:888739.

PMID: 35774121 PMC: 9239430. DOI: 10.3389/fonc.2022.888739.

Local full-thickness excision for sessile adenoma and cT1-2 rectal cancer: long-term oncological outcome.

Gascon M, Aguilella V, Martinez T, Antinolfi L, Valencia J, Ramirez J Langenbecks Arch Surg. 2022; 407(6):2431-2439.

PMID: 35732844 PMC: 9467953. DOI: 10.1007/s00423-022-02593-7.

A Meta-analysis of Transanal Endoscopic Microsurgery versus Total Mesorectal Excision in the Treatment of Rectal Cancer.

Ahmad N, Abbas M, Abunada M, Parvaiz A Surg J (N Y). 2021; 7(3):e241-e250.

PMID: 34541316 PMC: 8440057. DOI: 10.1055/s-0041-1735587.

Timing of recurrences of TEM resected rectal neoplasms is variable as per the surveillance practices of one tertiary care institution.

Keeping A, Johnson P, Kenyon C, Neumann K Sci Rep. 2021; 11(1):6509.

PMID: 33753765 PMC: 7985360. DOI: 10.1038/s41598-021-85885-0.

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