title: Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention.
abstract: OBJECTIVE
  After total mesorectal excision (TME) for rectal cancer, pathology is standardized with margin status as a predictor for recurrence. This has yet to be implemented after transanal endoscopic microsurgery (TEM) and was investigated prospectively for T1 rectal adenocarcinomas.
  
  
  METHODS
  Eighty patients after TEM were compared to 75 patients after TME. The study protocol included standardized pathology. TEM patients were eligible when excision margins were negative.
  
  
  RESULTS
  TEM was safer than TME as reflected by operating time, blood loss, hospital stay, morbidity, re-operation rate and stoma formation (all P<0.001). Mortality after TEM was 0% and after TME 4%. At 5 years after TEM and TME, both overall survival (TEM 75% versus TME 77%, P=0.9) and cancer-specific survival (TEM 90% versus TME 87%, P=0.5) were comparable. Local recurrence rate after TEM was 24% and after TME 0% (HR 79.266, 95% CI, 1.208 to 5202, P<0.0001).
  
  
  CONCLUSIONS
  For T1 rectal adenocarcinomas TEM is much saver than TME and survival is comparable. After TEM local recurrence rate is substantial, despite negative excision margins.
authors.affiliation: Department of General Surgery, IJsselland Hospital, PO Box 690, 2900 AR, Capelle aan den IJssel, The Netherlands. edgraaf@ysl.nl
authors.forename: E J R
authors.initials: EJ
authors.lastname: De Graaf
authors.forename: P G
authors.initials: PG
authors.lastname: Doornebosch
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: E
authors.initials: E
authors.lastname: Meershoek-Klein Kranenbarg
authors.forename: A C
authors.initials: AC
authors.lastname: de Boer
authors.forename: F C
authors.initials: FC
authors.lastname: Bekkering
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D018709:Statistics, Nonparametric; D054047:Surgical Stomas / Q000706:statistics & numerical data; D015996:Survival Rate; D016896:Treatment Outcome