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Analysis of national database for TEM resected rectal cancer
Author(s) -
Bach S.,
Mortensen N.
Publication year - 2007
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2006.01133_5.x
Subject(s) - medicine , colorectal cancer , surgery , radiation therapy , pathological , stoma (medicine) , stage (stratigraphy) , neoadjuvant therapy , adjuvant therapy , cancer , chemotherapy , paleontology , breast cancer , biology
Objective: Transanal endoscopic microsurgery (TEM) is a minimally invasive alternative to rectal resection for cancer. Patients benefit from rapid recovery, excellent function and stoma avoidance. Method: The national TEM database has prospectively collated data from 21 centres since 1993. Details of preoperative evaluation, neoadjuvant therapy, technical aspects of surgery, postoperative complications, pathological staging, salvage, recurrence and survival have been recorded for 454 cases of rectal cancer, median follow up 35 months. Results: Intention was curative in 69%, for compromise in 22% and palliative in 5%. The morbidity and mortality of TEM was 17.2% and 1.5%. Neoadjuvant radiotherapy was administered in 8% of cases. Pathological staging: pT0 (1.8%), pT1 (52.9%), pT2 (32.8%), pT3 (9.9%) and pTx (3.1%). Margin positivity (<1 mm) occurred in 20%; this was markedly stage dependent. 18% received adjuvant radiotherapy while 13% progressed to major surgery. 5 year disease free survival was 77% pT1, 74% pT2 and 35% pT3 with local recurrence rates of 20%, 25% and 59% respectively. Age ( P = 0.01), tumour area ( P = 0.02) and pT stage ( P = 0.07) predicted for relapse (Cox regression model). Conclusion: TEM offers a safe alternative to major surgery curing three quarters of patients with pT1 disease. Although classical surgery must remain the standard of care we envisage future studies of TEM combined with adjuvant therapy.