title: Transanal endoscopic microsurgery for rectal cancer. Long-term oncologic results.
abstract: OBJECTIVE
  Local excision of malignant rectal tumors remains controversial due to the lack of prospective studies. The principal aim of this paper is to analyze survival and recurrence of patients with rectal cancer who were operated by transanal endoscopic microsurgery with curative intention.
  
  
  METHODS
  In 1997, we started a prospective protocol for patients who had T1/T2 rectal tumors: transanal local full-thickness excision was considered curative in T1 low risk (group A); patients with T1 high-risk and T2 low-risk tumors received postoperative radiotherapy (group B). From 1997 to 2006, 88 patients were enrolled. Sixty eight entered the study after the preoperative workup and 20 patients with an initial diagnosis of adenoma after postoperative definitive pathological assessment.
  
  
  RESULTS
  After definitive histological findings, 54 patients were to group A, 28 to group B, and 6 had immediate radical surgery. One patient was lost for follow-up. At a mean follow-up of 71 months, 7 (4 from group A and 3 from group B) out of 81 patients recurred. Five-year overall survival was of 94% and cancer-specific survival of 96%.
  
  
  CONCLUSIONS
  Our data support that transanal endoscopic microsurgery is an adequate treatment for T1 low-risk tumor, and no additional measures are required. For T2 low-risk lesions, our study showed a higher local recurrence rate than that reported after radical surgery but a similar survival outcome.
authors.affiliation: Department of Colorectal Surgery, University Hospital, Zaragoza, Spain. jramirez@unizar.es
authors.forename: Jose M
authors.initials: JM
authors.lastname: Ramirez
authors.forename: Vicente
authors.initials: V
authors.lastname: Aguilella
authors.forename: Javier
authors.initials: J
authors.lastname: Valencia
authors.forename: Javier
authors.initials: J
authors.lastname: Ortego
authors.forename: Jose A
authors.initials: JA
authors.lastname: Gracia
authors.forename: Pilar
authors.initials: P
authors.lastname: Escudero
authors.forename: Ricardo
authors.initials: R
authors.lastname: Esco
authors.forename: Mariano
authors.initials: M
authors.lastname: Martinez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult