Published online Oct 27, 2024. doi: 10.4240/wjgs.v16.i10.3114
Revised: July 25, 2024
Accepted: September 3, 2024
Published online: October 27, 2024
Processing time: 110 Days and 10.8 Hours
Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail patients.
To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery (TEMS) approach carried out at three large cancer centers in the United Kingdom.
TEMS database was retrospectively reviewed to assess demographics, operative findings and post operative clinical and oncological outcomes. This is a retro
Two hundred and twenty-two patients underwent TEMS surgery. This included 144 males (64.9%) and 78 females (35.1%), Median age was 71 years. The median distance of the tumours from the anal verge 4.5 cm. Median tumour size was 2.6 cm. The most frequent operative position of the patient was lithotomy (32.3%), Full-thickness rectal wall excision was done in 204 patients. Median operating time was 90 minutes. Average blood loss was minimal. There were two 90-day mortalities. Complete excision of the tumour with free microscopic margins by > 1mm were accomplished in 171 patients (76.7%). Salvage total mesorectal excision was performed in 42 patients (19.8%). Median disease-free survival was 65 months (range: 3-146 months) (82.8%), and median overall survival was 59 months (0-146 months).
TEMS provides a promising option for early rectal cancers (Large adenomas-cT1/cT2N0), and selected therapy-responding cancers. Full-thickness complete excision of the tumour is mandatory to avoid jeopardising the oncological outcomes.
Core Tip: In this multi-centre study, Trans-anal endoscopic microsurgery was employed in 222 patients of early rectal cancers (T1-T2/early T3, N0), with acceptable oncologic outcomes and morbidity. The main independent factor of survival was the completeness of local excision, while completion total mesorectal excision did not offer a survival benefit. The limitations of this study were the heterogenicity of the data, its retrospective analysis, and the non-comparative design to the total mesorectal excision, which is the standard of care. However, this rectum preservation strategy can be a substitute in selected patients, especially in the evolving era of precision medicine.