Outcomes after transanal endoscopic microsurgery for early rectal cancer and risk factors associated with recurrence

Objective To investigate outcomes after transanal endoscopic microsurgery (TEM)for early rectal cancer, identify risk factors associated with recurrence, and explore the indication of TEM for rectal cancer. Methods Sixty patients with rectal cancer undergoing TEM between June 2006 and June 2009 in the Provincial Qianfoshan Hospital of Shandong University were included in this study and data were retrospectively analyzed. Results There were 12 patients with pTis rectal cancer, 38 with pT1 and 10 with pT2. All the lesions were excised en bloc by full-thickness TEM. No positive resection margins were reported. The operative time was (65.0±36.5) min. Estimated blood loss was (10.5±5.8) ml and hospital stay was (4.5±2.7) d. No perioperative mortality and complications occurred. The median follow-up was 28.5 (range, 12-48) months. No recurrence developed in pTis lesions. There was significant difference in local recurrence rate between pT1 and pT2 (2.6% vs.40.0%, P＜0.05). The recurrence rate in lesions larger than 3 cm in diameter (19.0%, 4/21) was significantly higher than that in lesions smaller than 3 cm in diameter (2.6% ,1/39) (P＜0.05).Multivariate analysis showed that depth of tumour invasion(T stage) and turnour size were independently associated with recurrence after TEM. Conclusion Local excision by TEM is oncologically safe and effective for pTis and pT1 rectal cancers and early lesions smaller than 3 cm in diameter. Key words: Rectal neoplasms;  Transanal endoscopic microsurgery;  Treatment outcome; Neoplasm recurrence