title: The outcome of rectal cancer after early salvage surgery following transanal endoscopic microsurgery seems promising.
abstract: BACKGROUND
  Transanal endoscopic microsurgery (TEM) allows locally complete resection of early rectal cancer as an alternative to conventional radical surgery. In patients with unfavourable post-TEM histology, salvage surgery can be performed. The aim of this study was to evaluate the results of early radical surgery after TEM for rectal cancer.
  
  
  METHODS
  From 1997 to 2010, 86 TEM procedures were performed in 79 patients due to rectal cancer. Early salvage surgery was performed in 25 patients. Data were obtained from the patients' charts and reviewed retrospectively. Perioperative data and oncological outcome were analysed.
  
  
  RESULTS
  No patients received preoperative chemotherapy. The median time to salvage surgery was 37 days. Five patients underwent laparoscopic surgery. The median operative time was 165 min (range: 101-341 min, 95% confidence interval (CI): 156-214 min) and the median blood loss 275 ml (range: 0-1,275 ml, 95% CI: 232-530 ml). The 30-day mortality was 8% (95% CI: 1-19%, n = 2). Intraoperative perforation occurred in 20% (95% CI: 3-37%, n = 5). The median number of harvested lymph nodes was 12 (range: 3-25, 95% CI: 9-14) and the median circumferential resection margin (CRM) was 10 mm (range: 0-20 mm, 95% CI: 5-12 mm). Only one patient (4%, 95%CI: 1-12%) had a positive CRM. The median follow-up time was 25 months (range: 3-80 months). There was no local recurrence. Distant metastasis occurred in 4% (95% CI: 1-12%, n = 1).
  
  
  CONCLUSIONS
  Early salvage surgery after TEM seems to be safe despite a high risk of specimen perforation during the operation.
  
  
  BACKGROUND
  not relevant.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: Gastroenheden, Kirurgisk Sektion, Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
authors.forename: Katarina
authors.initials: K
authors.lastname: Levic
authors.forename: Orhan
authors.initials: O
authors.lastname: Bulut
authors.forename: Peter
authors.initials: P
authors.lastname: Hesselfeldt
authors.forename: Steffen
authors.initials: S
authors.lastname: Bülow
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D057868:Anastomotic Leak / Q000209:etiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D008207:Lymphatic Metastasis; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome