Sphincter-saving surgery in patients with rectal cancer treated by radiotherapy and transanal endoscopic microsurgery: 10 years' experience

Background/Aims. Transanal endoscopic microsurgery (TEM) is a technique which allows minimally invasive full-thickness local excision of rectal tumours with perirectal fat dissection. Methods. Our study examined a group of 137 selected patients with rectal cancer treated by TEM excision combined with preoperative radiotherapy. The definitive histology was as follows: 37 patients with pT1 stage rectal cancer (27%), 59 with pT2 (43%) and 23 with pT3 (17%). In 18 (13%) patients who underwent a full dose of radiotherapy and TEM, the pathologist did not find cancer cells in the specimen (pT0). Results. Eleven (8%) patients developed minor complications, whereas three (2%) developed major complications. The perioperative mortality was nil. At the mean follow-up of 46 months (range 6-115 months), we observed seven (5%) local recurrences. Of those, three patients died from systemic spread of the disease at follow-up. The disease-free survival rate in T0 and T1 patients was 160%. The disease-free survival rates in T2 and T3 patients were 81 and 59%, respectively, at a mean follow-up of 46 months. Conclusions. The application of preoperative radiotherapy and TEM in the treatment of rectal tumours appears feasible, safe and effective in the present study, with optimal preservation of anal sphincter function. (C) 2003 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.