Abstract
Transanal endoscopic microsurgery (TEM) is widely used for the excision of rectal adenomas and early rectal adenocarcinoma. Few recommendations currently exist for surveillance of lesions excised by TEM. The purpose of this study was to review the surveillance practices and the patterns of recurrence among TEM resected lesions at a tertiary care hospital. A retrospective chart review was performed on all patients who underwent TEM for rectal adenoma or adenocarcinoma before June 2017. In our study population of 114 patients, the final pathology included 78 (68%) adenomas and 36 (32%) adenocarcinomas. Of the adenocarcinomas 23, 9, and 4 were T1, T2, T3 lesions, respectively. Of those, 25 patients opted for surveillance instead of further treatment. The most commonly recommended endoscopic surveillance strategy by our group for both adenomas and adenocarcinomas excised by TEM was flexible sigmoidoscopy every 6 months for 2 years. Recurrences occurred in 4/78 (5.1%) adenoma patients, all found within 16.9 months of surgery, and in 4/25 (16%) adenocarcinoma patients, found between 7.4 and 38.5 months post-surgery. Our data highlights the fact that the timing of recurrences post TEM surgery is variable. Further studies looking at recurrence patterns are needed in order to create comprehensive guidelines for surveillance of these patients.
Highlights
Colorectal cancer represents a significant contributor to disease burden in Canada and worldwide
Several studies have shown that T1 rectal adenocarcinoma can be safely removed by Transanal endoscopic microsurgery (TEM), with similar overall survival, reduced morbidity and shorter hospital stay compared with R R11–13, as well as low recurrence rates, most studies ranging from 0 to 13%5,6,10
Two patients were excluded who underwent TEM for palliative reasons; 2 had diagnosis other than adenoma or adenocarcinoma; 1 patient was excluded because surgery was aborted prior to attempt at dissection
Summary
Colorectal cancer represents a significant contributor to disease burden in Canada and worldwide. Several studies have shown that T1 rectal adenocarcinoma can be safely removed by TEM, with similar overall survival, reduced morbidity and shorter hospital stay compared with R R11–13, as well as low recurrence rates, most studies ranging from 0 to 13%5,6,10 This is still slightly higher than the risk of local recurrence with. Since TEM is associated with a higher rate of recurrence for T1 rectal cancer than radical resection adequate post-operative surveillance is especially important. This is true for many TEM-excised benign polyps because the lesions requiring TEM are often quite large at increased risk of recurrence. The American Society of Colon and Rectal Surgeons clinical practice guidelines state that “patients with T1 rectal cancer treated with local excision should be considered for surveillance, the evidence for its utility is conflicting”[16]
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