Outcomes for early rectal cancer managed with transanal endoscopic microsurgery - A 5-year follow-up study

Background: This study aimed to evaluate the long-term risk of local and distant recurrence as well as the survival of patients with early rectal cancer treated using transanal endoscopic microsurgery (TEM). Methods: The study reviewed 69 patients with T-is/T-1/T-2 rectal cancer treated using full-thickness excision between 1991 and 1999. The pathology T-stages included 25 T-is, 23 T-1, and 21 T-2. The median follow-up period was 6.5 years (range 5-10.2 years). Results: The overall local recurrence rate was 8.7%. The 5-year local recurrence rate was 8% for T-is, 8.6% for T-1, and 9.5% for T-2. All six patients with recurrence were managed Surgically. The 5-year disease-specific survival rate was 100% for T-is, 100% for T-1, and 70% for T-2. The overall cancer-related mortality rate was 7.2%. Conclusions: After local excision of early rectal cancer, a substantial local recurrence rate is observed. Patients with recurrent T-is/T-1 cancers who undergo a salvage operation may achieve good long-term outcome. Local treatment without adjuvant therapy for T-2 rectal cancers appears inadequate.