title: Endoscopic posterior mesorectal resection as an option to combine local treatment of early stage rectal cancer with partial mesorectal lymphadenectomy.
abstract: OBJECTIVE
  Low anterior resection and abdominoperineal resection with total mesorectal excision are the standard treatment in patients with low rectal cancer. Rectal resection remains a surgical intervention with considerable morbidity and long-term impairment of quality of life. Local excision of low rectal cancer is regarded as an alternative to radical surgery; however, occurrence of lymph node metastasis even in patients with highly differentiated early-stage rectal cancer may be underestimated.
  
  
  RESULTS
  In two patients with T1 rectal cancer, minimal-invasive partial excision of the mesorectum was performed after transanal excision of the tumor. The postoperative course was uneventful in both patients. Patients left the hospital on the fourth and fifth postoperative day without any complaints. In one patient, histo-pathological workup revealed a lymph node metastasis in the specimen.
  
  
  CONCLUSIONS
  The technique of "Endoscopic posterior mesorectal resection" represents an interesting option in the surgical treatment of rectal cancer, as it allows for the first time an organ preserving resection of local lymph nodes in the small pelvis. It may evolve as an efficient new staging procedure to identify patients with metastatic disease who may benefit from multimodal treatment or extended surgery.
authors.affiliation: Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Joerg_Koeninger@med.uni-heidelberg.de
authors.forename: Jörg
authors.initials: J
authors.lastname: Köninger
authors.forename: Beat P
authors.initials: BP
authors.lastname: Müller-Stich
authors.forename: Frank
authors.initials: F
authors.lastname: Autschbach
authors.forename: Peter
authors.initials: P
authors.lastname: Kienle
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Carsten N
authors.initials: CN
authors.lastname: Gutt
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003131:Combined Modality Therapy; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011351:Proctoscopy; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery; D012086:Reoperation