title: Local recurrence detection following transanal excision facilitated by EUS-FNA.
abstract: OBJECTIVE
  Local excision is an alternative management approach for early rectal cancers and patients unfit for radical surgery. It is associated with a high local recurrence rate. Our aims were to evaluate the rate, pattern, method of local recurrence detection, the opportunity for salvage resection and finally to explore the utility of endoscopic ultrasound fine needle aspiration during surveillance.
  
  
  METHODS
  A retrospective, non-controlled, cohort study from a single tertiary referral center comprised of patients undergoing surveillance following a transanal excision.
  
  
  RESULTS
  Post-operative surveillance was performed in 155 transanal excision patients of which 46 (30%) underwent =1 endoscopic ultrasound examinations. Intra and extra luminal recurrence (n=16/24; (67%)) was detected more frequently in the endoscopic ultrasound surveillance population, p=0.0008. Mucosal scar biopsy (n=10/16;63%) and endoscopic ultrasound fine needle aspiration (6/16; 38%) of either a lymph node or the deep rectal wall were the methods for establishing local recurrence. An unremarkable proctoscopy with endoscopic ultrasound fine needle aspiration positive cytological findings was noted in 4 (9%) of the patients.
  
  
  CONCLUSIONS
  Local recurrence following transanal excision is often in an intraluminal location. Endoscopic ultrasound fine needle aspiration confirmed nodal metastases in mesenteric and extra mesenteric locations more frequently than subepithelial locations.
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA. gleeson.ferga@mayo.edu
authors.forename: Ferga C
authors.initials: FC
authors.lastname: Gleeson
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dozois
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Boardman
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Clain
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rajan
authors.forename: Mark D
authors.initials: MD
authors.lastname: Topazian
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D044963:Biopsy, Fine-Needle / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy