title: Long-term outcomes of radical surgery after gasless video endoscopic transanal excision of T1/T2 rectal cancers.
abstract: OBJECTIVE
  We aim to clarify the long-term outcomes after an additional radical operation following gasless video endoscopic transanal rectal tumour excision (gasless VTEM) of 'high-risk' T1 and T2 rectal cancer.
  
  
  METHODS
  Gasless VTEM involves modification of transanal endoscopic microsurgery (TEM) by incorporating a standard laparoscopic video camera without a CO(2) insufflation system. This study between 1993 and 2003 included six men and five women with a median age of 64 years (range, 36-79). Specimens resected by gasless VTEM revealed (1) high-risk T1 carcinomas with one of the following histological types: poorly differentiated, lymphovascular invasion, and massive invasion of the submucosa (submucosal invasion greater than 200-300 microm from the muscularis mucosa) and (2) T2 carcinomas.
  
  
  RESULTS
  Eight patients had a high-risk T1 carcinoma and three patients had a T2 carcinoma. In two patients with a high-risk T1 carcinoma, a residual tumour was found in the specimen resected by the additional radical surgery. At a median follow-up of 86.5 months (range, 63.2-110.5), none of the patients developed tumour recurrence. Although one patient died with cancer at another organ site (hilar cholangiocarcinoma of the liver) 87 months after the additional radical surgery, the other 10 patients are alive and disease free.
  
  
  CONCLUSIONS
  This study revealed favorable long-term outcomes after additional radical surgery following gasless VTEM in patients with high-risk T1 and T2 carcinomas.
authors.affiliation: First Department of Surgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. nakagoe@net.nagasaki-u.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Nakagoe
authors.forename: H
authors.initials: H
authors.lastname: Ishikawa
authors.forename: T
authors.initials: T
authors.lastname: Sawai
authors.forename: T
authors.initials: T
authors.lastname: Tsuji
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods*; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D014741:Video Recording