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. 2022 Sep;407(6):2431-2439.
doi: 10.1007/s00423-022-02593-7. Epub 2022 Jun 22.

Local full-thickness excision for sessile adenoma and cT1-2 rectal cancer: long-term oncological outcome

Maria A Gascon  1 , Vicente Aguilella  1 , Tomas Martinez  2 , Luigi Antinolfi  1 , Javier Valencia  3 , Jose M Ramírez  4   5
Affiliations

Local full-thickness excision for sessile adenoma and cT1-2 rectal cancer: long-term oncological outcome

Maria A Gascon et al. Langenbecks Arch Surg. 2022 Sep.

Abstract

Purpose: We analyzed all patients who underwent local transanal surgery at our institution to determine oncological outcomes and perioperative risk.

Methods: In 1997, we developed a prospective protocol for rectal tumors: transanal local full-thickness excision was considered curative in patients with benign adenoma and early cancers. In this analysis, 404 patients were included. To analyze survival, only those patients exposed to the risk of dying for at least 5 years were considered for the study.

Results: The final pathological analysis revealed that 262 (64.8%) patients had benign lesions, whereas 142 had malignant lesions. Postoperative complications were recorded in 12.6%. At the median time of 21 months, 14% of the adenomas and 12% of cancers had recurred, half of which were surgically resected. The overall 5-year survival rate was 94%.

Conclusion: With similar outcomes and significantly lower morbidity, we found local surgery to be an adequate alternative to radical surgery in selected cases of early rectal cancer.

Keywords: Local surgery; Oncological outcome; Rectal adenoma; Rectal cancer; Rectal surgery; Transanal endoscopic microsurgery.

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Conflict of interest statement

JMRR shares a rectoscope patent from Richard Word GmbH. MAGD, VAD, TMT, AG, and JV have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Distribution and outcomes of the patients according to our protocol. *Full information is given to the patient before and after surgery for shared decision-making. **In cancers, high risk was defined if any of the following characteristics were mentioned in the pathology report: poor differentiation, lymphatic or venous invasion, or a clear resection margin of less than 1 mm. ***Low risk was defined when the cancers did not have any of the high risk characteristics
Fig. 2
Fig. 2
Disease-free survival curve (n = 98) stratified by groups
See this image and copyright information in PMC

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