TRANSANAL ENDOSCOPIC MICROSURGICAL EXCISION OF IRRADIATED AND NONIRRADIATED RECTAL-CANCER - A 5-YEAR EXPERIENCE

Transanal endoscopic microsurgery (TEM allows minimally invasive full- thickness local excision of rectal tumors with perirectal fat dissecti on. Thirty-seven patients with extraperitoneal octal carcinoma underwe nt full thickness TEM resection for T1 (10 patients), T2 (20 patients) , and T3 (6 patients) lesions, with associated radiotherapy in the sec ond and third group. One patient, staged as T2, underwent full-dose ra diotherapy and TEM and the pathologist did not find cancer cells on th e specimen (pT0). Morbidity included wound dehiscence and stool incont inence in three and two patients, respectively, that resolved with med ical therapy and rectovaginal fistula in one patient that required reo peration. No perioperative mortality was observed. Mean follow-up was 35 months (range 17-60 months), with two local recurrences (5.4%) that were successfully retreated. Cancer-related mortality due to systemic metastases was 8.1%. This is the first clinical study reporting on th e application of TEM combined with radiotherapy for the treatment of T 2 and T3 rectal cancer in selected patients. This approach is feasible , safe, and appears to be effective at the present duration of follow- up, with preservation of normal anal sphincter function.