title: Local excision of rectal cancer with transanal endoscopic microsurgery (TEM).
abstract: BACKGROUND
  Local excision for T1 rectal cancers with Transanal Endoscopic Microsurgery (TEM) is an accepted standard of care. However for T2/T3 rectal cancers, the high local failure indicates that this is not a valid option.
  
  
  METHODS
  Between 1990 and 2000, 83 patients with rectal adenocarcinoma underwent complete full thickness local excision. The mean diameter of the tumor was 3.4+/-1.7 cm, 60% were located more than 5 cm from the anal verge; 43% of patients received radiation therapy (26 pre- and 10 postoperatively).
  
  
  RESULTS
  Postoperative complications occurred in 15 patients (18%); there were no postoperative deaths. Mean follow-up was 37 months (range 18-118). The pathological stage was: Tis 9, T1 39, T2 23, T3 12. The overall local recurrence rate was 0% for Tis, 13% for T1, 17% for T2 and 50% for T3. Recurrence was managed surgically in 65% and nonsurgically in 35% because of advanced disease or poor general condition. Overall 5-year survival rates were 100%, 92%, 75% and 69% for Tis, T1, T2 and T3, respectively.
  
  
  CONCLUSIONS
  Local excision with TEM is effective for early (Tis, T1) rectal cancers. Patients with T2 tumors can be treated with preoperative chemoradiation and subsequently local resection. Patients with T3 should not be treated with local excision unless they are unable to tolerate more extensive surgery.
authors.affiliation: Third Department of Surgery, Hosp. S. Giovanny-Addolorata, Rome, Italy. fralilu@katamail.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Stipa
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lucandri
authors.forename: Mario
authors.initials: M
authors.lastname: Ferri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Casula
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ziparo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D011351:Proctoscopy / Q000009:adverse effects / Q000379:methods*; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*