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

O’Neill, Conor H. M.D.; Platz, Joseph M.D.; Moore, Jesse S. M.D.; Callas, Peter W. Ph.D.; Cataldo, Peter A. M.D.

doi: 10.1097/DCR.0000000000000764
Original Contributions: Colorectal/Anal Neoplasia
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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.

1 Department of Surgery, University of Vermont, Burlington, Vermont

2 Department of Biostatistics, University of Vermont, Burlington, Vermont

Financial Disclosure: None reported.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Boston, MA, May 30 to June 3, 2015.

Correspondence: Peter A. Cataldo, M.D., Smith 301, Department of Surgery, University of Vermont Medical Center, Burlington, VT 05401. E-mail: tina.blais-armell@vtmednet.org

© 2017 The American Society of Colon and Rectal Surgeons