title: Functional and clinical results of transanal endoscopic microsurgery combined with endoscopic posterior mesorectum resection for the treatment of patients with t1 rectal cancer.
abstract: BACKGROUND
  Rectum-sparing transanal endoscopic microsurgery (TEM) is a well-established treatment for T1 carcinomas of the rectum. However, it is associated with an increased rate of local recurrence compared with extended resection. In most cases, this failure is linked to the presence of clinically nondetectable metastases in the regional lymph nodes. Endoscopic posterior mesorectal resection (EPMR) makes it possible to remove the relevant lymphatic drainage of the lower third of the rectum in the minimally invasive way, which can help with adequate tumor staging. The study evaluated the influence of combined TEM and EPMR treatment on the anorectal functions of this group of patients.
  
  
  METHODS
  Six consecutive patients (3 women and 3 men; mean age, 71.3 years) with T1 cancer of the rectum were operated on using TEM in combination with EPMR as a two-stage procedure between 2007 and 2009.
  
  
  RESULTS
  After a median follow-up of 19 (range, 8-30) months, none of our patients complained of symptoms of incontinence during the postoperative period apart from one woman with gas incontinence, who was diagnosed preoperatively. There was no statistically significant difference in BAP, SAP, HPZL, or in fecal continence control assessed using the Fecal Incontinence Severity Index before and 1, 3, and 6 months after the procedure. We observed one case of intraoperative complication (perforation) and one case of minor postoperative complication (hematoma formation). There was no evidence of locoregional recurrence.
  
  
  CONCLUSIONS
  EPMR in combination with TEM seems to be safe, feasible, and with no impact on the basic anorectal functions.
authors.affiliation: 3rd Department of General Surgery, Jagiellonian University School of Medicine, Pradnicka 35-37, 31-202, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Walega
authors.forename: Jakub
authors.initials: J
authors.lastname: Kenig
authors.forename: Piotr
authors.initials: P
authors.lastname: Richter
authors.forename: Wojciech
authors.initials: W
authors.lastname: Nowak
mesh_terms: D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008866:Microsurgery / Q000379:methods; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome