Piotrwalega, Jakub Kenig* and Wojciech Nowak
Department of General Surgery, Jagiellonian University School of Medicine, PolandFulltext PDF
Background: Transanal Endoscopic Microsurgery (TEM) combined with Endoscopic Posterior Mesorectal Excision (EPMR) as a two-stage procedure allows a radical resection of T1 rectal cancer and the relevant lymphatic drainage of the lower third of the rectum. The aim of the study was to assess the 5-year oncologic results of TEM combined with EPMR in the treatment of T1 rectal cancer in older patients.Methods: Patients aged 69 or over with T1 cancer of the lower third of the rectum was examined in a prospective study between 2007 and 2016. All of them were treated with TEM in combination with EPMR in a two-stage procedure.Results: Ten consecutive elderly patients (5 female and 5 male, mean age 73.5 years): in all patients, a full-thickness excision of the primary tumor was performed using TEM with a radial margin of at least 10 mm. In the second stage, 4-6 week later, EPMR was performed. There were no intraoperative complications apart from one small rectum perforation during EPMR which did not require conversion and was treated endoscopically. In the postoperative period, one patient had a hematoma which resolved itself without any additional treatment and one male patient complained of sexual dysfunction until 6 months postoperatively. The symptoms resolved themselves later without any additional treatment. There was no mortality or treatment related morbidity in the 60-month follow-up. In this time period we also did not observe any locoregional recurrence. None of our patients complained of any incontinence symptoms in the postoperative period apart from one female patient with fecal incontinence diagnosed preoperatively (gas incontinence).Conclusion: TEM in combination with EPMR is a safe procedure, with a low complication rate and good long-term oncologic results. This could be especially attractive in frail, elderly patients that do not qualify for an extended resection. However, it requires further evaluation using a larger study group.
Piotrwalega, Kenig J, Nowak W. Long-Term Oncologic Results of Transanal Endoscopic Microsurgery Combined with Endoscopic Posterior Mesorectum Resection in the Treatment of Elderly Patients with T1 Rectal Cancer. Clin Surg. 2016; 1: 1243.