Experience of minimally invasive treatment for early rectal cancer

Abstract

Objective. The aim of this study is to evaluate the experience with minimally invasive transanal operations and to improve treatment results in patients with early rectal cancer; to assess the accuracy of endorectal ultrasound (ERUS) in preoperative staging of rectal cancer. Materials and methods. The present clinical trial includes 38 selected patients who were underwent minimally invasive transanal procedures for early rectal cancers. 22 (58 %) patients were operated by transanal endoscopic microsurgery, 16 (42 %) were underwent transanal local excision. The study population consisted of 20 men and 18 women; average age was 64 (range 42–84) years. The main outcome measures included the operation time, the intra- and postoperative complication rate, negative microscopic margin rate, specimen fragmentation rate, oncological results (local recurrence and distant metastasis rate). Comparison of ERUS preoperative staging and pathological staging was performed to identify the accuracy of ERUS. The postoperative surveillance protocol was applied to all patients. Results. The median operative time was 56 (30–110) minutes. Postoperative complications occurred in 2 patients (5.2 %). There was no mortality. All pathological specimens were removed en block without fragmentation. Final histology revealed pTis – 10 (26 %), pT1sm1 – 9 (24 %), pT1sm2 – 12 (32 %), pT1sm3 – 5 (13 %) and pT2 – 2 (5 %) adenocarcinomas with negative resection margins (R0). The overall accuracy of ERUS for preoperative T stage was 78.9 %; for Tis was 80.0 % and for T1 – 85.0 %. All 7 patients in the pT1sm3 and pT2 groups were offered immediate radical surgery or adjuvant chemoradiotherapy. The follow-up period was from 5 to 60 (median 36) months. There was one local recurrence (2.6 %) in 6 months after local excision in a patient with pT1sm3. This patient underwent total mesorectumectomy. Conclusions. Selected patients with “low-risk” early rectal cancer and favorable features may be effectively treated with minimally invasive transanal operations without jeopardizing long-term oncological results. The lack of lymphadenectomy represents the main concern of this approach for the treatment of rectal cancer. Further follow-up is necessary. Preoperative ERUS has a good accuracy with pathologic T stage and can guide transanal procedure in early rectal cancer.

Keywords

• early rectal cancer
• local excision
• transanal endoscopic microsurgery
• endorectal ultrasound