title: Local excision of early rectal cancer: is transanal endoscopic microsurgery an alternative to radical surgery?
abstract: OBJECTIVE
  Transanal endoscopic microsurgery (TEM) allows locally complete excision of rectal neoplasms and provides an alternative to conventional surgery for benign tumours. However, its role in the curative treatment of invasive carcinoma is controversial. This paper examines the results of TEM compared with radical surgery (RS) for T1 rectal cancer.
  
  
  METHODS
  51 patients with T1 rectal tumours treated by RS, or local excision by means of TEM were included. The following parameters were evaluated: operating time, blood loss, hospital stay and complications, as well as local recurrence rate and survival.
  
  
  RESULTS
  17 patients were treated by RS and 34 by TEM. Operative time, blood loss, and duration of hospitalization were significantly lower in the TEM group compared with the RS group. In the RS group there were 4 patients with complications which required an operative revision (23.5%), compared to 1 reintervention (2.9%) in the TEM group. Local recurrence was 5.88% (n = 2) in the TEM group compared with none after RS (p = 0.547). The overall survival and disease-free survival showed not significant statistical differences between both groups (p = 0.59; p = 1.000, resp.).
  
  
  CONCLUSIONS
  Although local recurrence was only observed after local excision, patients treated with TEM showed no significant differences in terms of overall survival and disease-free survival compared with patients who underwent RS. Inasmuch as local excision represents a minimally invasive technique in terms of morbidity, mortality and functional outcome, TEM should be offered as a valid option for well selected patients with early rectal cancer.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Medical School Mannheim, University of Heidelberg, Germany. pablopalma@andaluciajunta.es
authors.forename: P
authors.initials: P
authors.lastname: Palma
authors.forename: K
authors.initials: K
authors.lastname: Horisberger
authors.forename: A
authors.initials: A
authors.lastname: Joos
authors.forename: S
authors.initials: S
authors.lastname: Rothenhoefer
authors.forename: F
authors.initials: F
authors.lastname: Willeke
authors.forename: S
authors.initials: S
authors.lastname: Post
mesh_terms: D000368:Aged; D001003:Anal Canal; D013505:Digestive System Surgical Procedures / Q000379:methods; D016099:Endoscopy, Gastrointestinal; D006801:Humans; D008866:Microsurgery; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies