Skip to main content

Advertisement

SpringerLink
Log in

Oncological Outcome After Local Excision of Rectal Carcinomas

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Background

Local excision (LE) of T1 rectal cancer yields low recurrence rates. However, more frequent recurrences with unknown states of high-risk T1/T2 tumors are risk factors. The purpose of this study was to evaluate if, after LE, immediate reoperation is required, or awaiting salvage surgery is sufficient.

Methods

150 T1 and 42 T2 tumors were treated by LE. Immediate reoperation was attempted for unfavorable pT1 (G3-4/L1/V1/R1/Rx/R ≤1 mm) and all pT2 tumors. Three groups were formed. Group A included low-risk pT1 tumors after complete (R0) LE; unfavorable pT1 and all T2 tumors were divided in groups B (immediate reoperation) and C (salvage surgery).

Results

Groups A (n = 93) and B (n = 39) showed high tumor-free (TFS) and tumor-related survival (TRS) rates: group A 92% and 98%; group B 86% and 89%. In group C (n = 43), the TFS und TRS were significantly lower with 54% and 72%. Group A showed low recurrence rates and a wide range of International Union Against Cancer (UICC) stages. In group B, similarly low recurrence rates were found, but, in contrast, all recurrences were UICC IV. Group C had significantly higher recurrences rates and, in addition, two-thirds of these patients showed advanced UICC stages (III–IV).

Conclusions

LE of low-risk T1 tumors represents an adequate therapy. Immediate reoperation after LE of pT1 tumors with unfavorable histological finding or pT2 tumors can avoid local recurrences. Thereafter, high TFS rates can be expected in these patients, but metastases cannot be prevented and adjuvant measures are necessary. Awaiting recurrences as in group C leads to bad oncological outcomes with high recurrences and low survival rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Borschitz T, Junginger T. Value of local surgical therapy of rectal cancer. A literature analysis. Zentralbl Chir 2003;128:1066–74

    Article  PubMed  CAS  Google Scholar 

  2. Borschitz T, Heintz A, Junginger T. The influence of histopathologic criteria on the long-term prognosis of locally excised pT1 rectal carcinomas: results of local excision (transanal endoscopic microsurgery) and immediate reoperation. Dis Colon Rectum 2006;49:1492–506; discussion 1500–05

    Article  PubMed  Google Scholar 

  3. Bretagnol F, Merrie A, George B, et al. Local excision of rectal tumours by transanal endoscopic microsurgery. Br J Surg 2007;94:627–33

    Article  PubMed  CAS  Google Scholar 

  4. Duek SD, Krausz MM, Hershko DD. Transanal endoscopic microsurgery for rectal cancer. Isr Med Assoc J 2005;7:435–8

    PubMed  Google Scholar 

  5. Faivre J, Chaume J, Pigot F, et al. Transanal electroresection of small rectal cancer: a sole treatment? Dis Colon Rectum 1996;39:270–8

    Article  PubMed  CAS  Google Scholar 

  6. Ganai S, Kanumuri P, Rao RS, et al. Local recurrence after transanal endoscopic microsurgery for rectal polyps and early cancers. Ann Surg Oncol 2006;13:547–56

    Article  PubMed  Google Scholar 

  7. Gonzalez QH, Heslin MJ, Shore G, et al. Results of long-term follow-up for transanal excision for rectal cancer. Am Surg 2003;69:675–8

    PubMed  Google Scholar 

  8. Hahnloser D, Wolff BG, Larson DW, et al. Immediate radial resection after local excision of rectal cancer: an oncologic compromise? Dis Colon Rectum 2005;48:429–37

    Article  PubMed  Google Scholar 

  9. Kim DG, Madoff RD. Transanal treatment of rectal cancer: ablative methods and open resection. Semin Surg Oncol 1998;15:101–13

    Article  PubMed  CAS  Google Scholar 

  10. Koscinski T, Malinger S, Drews M. Local excision of rectal carcinoma not exceeding the muscularis layer. Colorectal Dis 2003;5:159–63

    Article  PubMed  CAS  Google Scholar 

  11. Langer C, Markus P, Liersch T, et al. UltraCision or high-frequency knife in transanal endoscopic microsurgery (TEM)? Advantages of a new procedure. Surg Endosc 2001;15:513–7

    Article  PubMed  CAS  Google Scholar 

  12. Lee W, Lee D, Choi S, et al. Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer. Surg Endosc 2003;17:1283–7

    Article  PubMed  CAS  Google Scholar 

  13. Maslekar S, Pillinger SH, Monson JR. Transanal endoscopic microsurgery for carcinoma of the rectum. Surg Endosc 2007;21:97–102

    Article  PubMed  CAS  Google Scholar 

  14. Marks JH, Marchionni C, Marks GJ. Transanal endoscopic microsurgery in the treatment of select rectal cancers or tumors suspicious for cancer. Surg Endosc 2003;17:1114–7

    Article  PubMed  CAS  Google Scholar 

  15. Mentges B, Buess G, Effinger G, et al. Indications and results of local treatment of rectal cancer. Br J Surg 1997;84:348–51

    Article  PubMed  CAS  Google Scholar 

  16. Middleton PF, Sutherland LM, Maddern GJ. Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 2005;48:270–84

    Article  PubMed  Google Scholar 

  17. Nakagoe T, Sawai T, Tsuji T, et al. Local rectal tumor resection results: gasless, video-endoscopic transanal excision versus the conventional posterior approach. World J Surg 2003;27:197–202

    PubMed  Google Scholar 

  18. Schäfer H, Baldus SE, Gasper F, et al. Submucosal infiltration and local recurrence in pT1 low-risk rectal cancer treated by transanal endoscopic microsurgery. Chirurg 2005;76:379–84

    Article  PubMed  Google Scholar 

  19. Sengupta S, Tjandra JJ. Local excision of rectal cancer: what is the evidence? Dis Colon Rectum 2001;44:1345–61

    Article  PubMed  CAS  Google Scholar 

  20. Sharma A, Hartley J, Monson JRT. Local excision of rectal tumors. Surg Oncol 2003;12:51–61

    Article  PubMed  Google Scholar 

  21. Slisow W, Moesta KT, Schlag PM. Local excision of rectal cancer through windowed specula: long-term results. Recent Result Cancer Res 1998;146:114–23

    CAS  Google Scholar 

  22. Suzuki H, Furukawa K, Kan H, et al. The role of transanal endoscopic microsurgery for rectal tumors. J Nippon Med Sch 2005;72:278–84

    Article  PubMed  Google Scholar 

  23. Winde G, Nottberg H, Keller R, et al. Surgical cure for early rectal carcinomas (T1): transanal endoscopic microsurgery vs. anterior resection. Dis Colon Rectum 1996;39:969–76

    Article  PubMed  CAS  Google Scholar 

  24. Benson R, Wong CS, Cummings BJ, et al. Local excision and postoperative radiotherapy for distal rectal cancer. Int J Radiat Oncol Biol Phys 2001;50:1309–16

    PubMed  CAS  Google Scholar 

  25. Borschitz T, Heintz A, Junginger T. Transanal endoscopic microsurgical excision of pT2 rectal cancer: Results and possible indications. Dis Colon Rectum 2007;50:292–301

    Article  PubMed  Google Scholar 

  26. Chakravarti A, Compton CC, Shellito PC, et al. Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg 1999;230:49–54

    Article  PubMed  CAS  Google Scholar 

  27. Friel CM, Cromwell JW, Marra C, et al. Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum 2002;45:875–9

    Article  PubMed  Google Scholar 

  28. Garcia-Aguilar J, Mellgren A, Sirivongs P, et al. Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg 2000;231:345–51

    Article  PubMed  CAS  Google Scholar 

  29. Lamont JP, McCarty TM, Digan RD, et al. Should locally excised T1 rectal cancer receive adjuvant chemoradiation? Am J Surg 2000;180:402–6

    Article  PubMed  CAS  Google Scholar 

  30. Mellgren A, Sirivongs P, Rothenberger DA, et al. Is local excision adequate therapy for rectal cancer? Dis Colon Rectum 2000;43:1064–74

    Article  PubMed  CAS  Google Scholar 

  31. Paty PB, Nash GM, Baron P, et al. Long-term results of local excision for rectal cancer. Ann Surg 2002;236:522–9

    Article  PubMed  Google Scholar 

  32. Taylor RH, Hay JH, Larsson SN. Transanal local excision of selected low rectal cancer. Am J Surg 1998;175:360–3

    Article  PubMed  CAS  Google Scholar 

  33. Wagman R, Minsky BD, Cohen AM, et al. Conservative management of rectal cancer with local excision and postoperative adjuvant therapy. Int J Radiat Oncol Biol Phys 1999;44:841–6

    PubMed  CAS  Google Scholar 

  34. Gopaul D, Belliveau P, Vuong T, et al. Outcome of local excision of rectal carcinoma. Dis Colon Rectum 2004;47:1780–8

    Article  PubMed  CAS  Google Scholar 

  35. Endreseth BH, Myrvold HE, Romundstad P, et al. The Norwegian Rectal Cancer Group. Transanal excision vs. major surgery for T1 rectal cancer. Dis Colon Rectum 2005;48:1380–8

    Article  PubMed  Google Scholar 

  36. Langer C, Liersch T, Suss M, et al. Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection. Int J Colorectal Dis 2003;18:222–9

    PubMed  CAS  Google Scholar 

  37. Bouvet M, Milas M, Giacco GG, et al. Predictors of recurrence after local excision and postoperative chemoradiation therapy of adenocarcinoma of the rectum. Ann Surg Oncol 1999;6:26–32

    Article  PubMed  CAS  Google Scholar 

  38. Le Voyer TE, Hoffman JP, Cooper H, et al. Local excision and chemoradiation for low rectal T1 and T2 cancers is an effective treatment. Am Surg 1999;65:625–30

    PubMed  CAS  Google Scholar 

  39. Minsky BD, Enker WE, Cohen AM, et al. Local excision and postoperative radiation therapy for rectal cancer. Am J Clin Oncol 1994;17:411–6

    Article  PubMed  CAS  Google Scholar 

  40. Russell AH, Harris J, Rosenberg PJ, et al. Anal sphincter conservation for patients with adenocarcinoma of the distal rectum: long-term results of radiation therapy oncology group protocol 89-02. Int J Radiat Oncol Biol Phys 2000;46:313–22

    Article  PubMed  CAS  Google Scholar 

  41. Saclarides TJ. Transanal endoscopic microsurgery: a single surgeon’s experience. Arch Surg 1998;133:595–8

    Article  PubMed  CAS  Google Scholar 

  42. Steele GD Jr, Herndon JE, Bleday R, et al. Sphincter-sparing treatment for distal rectal adenocarcinoma. Ann Surg Oncol 1999;6:433–41

    Article  PubMed  Google Scholar 

  43. Willett CG. Local excision followed by postoperative radiation therapy. Semin Radiat Oncol 1998;8:24–9

    Article  PubMed  CAS  Google Scholar 

  44. Buess G, Hutterer F, Theiss J, et al. A system for a transanal endoscopic rectum operation. Chirurg 1984;55:677–80

    PubMed  CAS  Google Scholar 

  45. Hermanek P. A pathologist’s point of view on endoscopically removed polyps of the colon and rectum. Acta Hepatogastroenterol (Stuttg) 1978;25:169–70

    CAS  Google Scholar 

  46. Coverlizza S, Risio M, Ferrari A, et al. Colorectal adenomas containing invasive carcinoma. Pathologic assessment of lymph node metastatic potential. Cancer 1989;64:1937–47

    Article  PubMed  CAS  Google Scholar 

  47. Jass JR, Atkin WS, Cuzick J, et al. The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases. Histopathology 1986;10:437–59

    Article  PubMed  CAS  Google Scholar 

  48. Jass JR. Lymphocytic infiltration and survival in rectal cancer. J Clin Pathol 1986;39:585–9

    Article  PubMed  CAS  Google Scholar 

  49. Soreide O, Norstein J, Fielding LP, et al. International standardisation and documentation of the treatment of rectal cancer. In Soreide O, Norstein J (eds): Rectal Cancer Surgery. Optimisation—Standardisation—Documentation. Springer, Berlin 1997

    Google Scholar 

  50. American Joint Committee on Cancer (AJCC). Cancer staging manual, 6th edition. (Greene FL, Page DL, Fleming ID, et al., eds) New York, Berlin, Heidelberg, AJCC: Springer, 2002

  51. UICC. TNM classification of malignant tumors, 6th edition. (Sobin LH, Wittekind Ch, eds). New York: Wiley, 2002

  52. Bentrem DJ, Okabe S, Wong WD, et al. T1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg 2005;242:472–7; discussion 477–9

    PubMed  Google Scholar 

  53. Floyd ND, Saclarides TJ. Transanal endoscopic microsurgical resection of pT1 rectal tumors. Dis Colon Rectum 2006;49:164–8

    Article  PubMed  Google Scholar 

  54. Helgstrand F, Iversen E, Bech K. Transanal endoscopic microsurgery. The latest 5 years’ experience in Roskilde County. Ugeskr Laeger 2007;169:1784–8

    PubMed  Google Scholar 

  55. Wirsing K, Lorenzo-Rivero S, Luchtefeld M, et al. Local excision of stratified T1 rectal cancer. Am J Surg 2006;191:410–2

    Article  PubMed  Google Scholar 

  56. Madbouly KM, Remzi FH, Erkek BA, et al. Recurrence after transanal excision of T1 rectal cancer: should we be concerned? Dis Colon Rectum 2005;48:711–9; discussion 719–21

    Article  PubMed  Google Scholar 

  57. Whitehouse PA, Armitage JN, Tilney HS, et al. Transanal endoscopic microsurgery: local recurrence rate following resection of rectal cancer. Colorectal Dis 2008;10:187–93

    PubMed  CAS  Google Scholar 

  58. Baron PL, Enker WE, Zakowski MF, et al. Immediate vs. salvage resection after local treatment for early rectal cancer. Dis Colon Rectum 1995;38:177–81

    Article  PubMed  CAS  Google Scholar 

  59. Nakagoe T, Ishikawa H, Sawai T, et al. Long-term outcomes of radical surgery after gasless video endoscopic transanal excision of T1/T2 rectal cancers. Eur J Surg Oncol 2004;30:638–42

    Article  PubMed  CAS  Google Scholar 

  60. Weiser MR, Landmann RG, Wong WD, et al. Surgical salvage of recurrent rectal cancer after transanal excision. Dis Colon Rectum 2005;48:1169–75

    Article  PubMed  Google Scholar 

  61. Lopez-Kostner F, Fazio VW, Vignali A, et al. Locally recurrent rectal cancer: predictors and success of salvage surgery. Dis Colon Rectum 2001;44:173–8

    Article  PubMed  CAS  Google Scholar 

  62. Ambacher T, Kasperk R, Schumpelick V. Tumor recurrence after transanal excision of stage I rectal cancer in comparison with radical resection. Chirurg 1990;70:1469–74

    Article  Google Scholar 

  63. Willett CG, Compton CC, Shellito PC, et al. Selection factors for local excision or abdominoperineal resection of early stage rectal cancer. Cancer 1994;73:2716–20

    Article  PubMed  CAS  Google Scholar 

  64. Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 2001;358:1291–304

    Google Scholar 

  65. Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. Gastrointestinal Tumor Study Group. N Engl J Med 1985;312:1465–72

    Google Scholar 

  66. Hobday TJ. An overview of approaches to adjuvant therapy for colorectal cancer in the United States. Clin Colorectal Cancer 2005;5:11–8

    Article  Google Scholar 

  67. Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991;324:709–15

    PubMed  CAS  Google Scholar 

  68. Minsky BD. Adjuvant therapy for rectal cancer—the transatlantic view. Colorectal Dis 2003;5:416–22

    Article  PubMed  CAS  Google Scholar 

  69. NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444–50

    Article  Google Scholar 

  70. O’Connell MJ, Laurie JA, Kahn M, et al. Prospectively randomized trial of postoperative adjuvant chemotherapy in patients with high-risk colon cancer. J Clin Oncol 1998;16:295–300

    PubMed  CAS  Google Scholar 

  71. Tveit KM, Guldvog I, Hagen S, et al. Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. Norwegian Adjuvant Rectal Cancer Project Group. Br J Surg 1997;84:1130–5

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinic of General and Abdominal Surgery, Johannes Gutenberg-University Hospital, Langenbeckstr. 1, 55131, Mainz, Germany

    Thomas Borschitz MD, Ines Gockel MD & Theodor Junginger MD

  2. First Department of Internal Medicine, Johannes Gutenberg-University Hospital, Mainz, Germany

    Ralf Kiesslich MD

Authors
  1. Thomas Borschitz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ines Gockel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ralf Kiesslich MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Theodor Junginger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Borschitz MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Borschitz, T., Gockel, I., Kiesslich, R. et al. Oncological Outcome After Local Excision of Rectal Carcinomas. Ann Surg Oncol 15, 3101–3108 (2008). https://doi.org/10.1245/s10434-008-0113-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-008-0113-x

Keywords

Search

Navigation