title: Transanal endoscopic microsurgery combined with endoscopic posterior mesorectum resection in the treatment of patients with T1 rectal cancer - 3-year results.
abstract: BACKGROUND
  Rectum-sparing transanal endoscopic microsurgery (TEM) is a well-established treatment for T1 rectal cancer (RC). However, it is associated with an increased rate of local recurrence in comparison with extended resection. In most cases this failure is linked to inappropriate case selection and the presence of clinically non-detectable 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 a minimally invasive way, which in turn can help in adequate tumor staging.
  
  
  OBJECTIVE
  To evaluate the long-term clinical results and influence of combined TEM and EPMR treatment on the anorectal functions.
  
  
  METHODS
  Ten consecutive patients with T1 RC were operated on using TEM and EPMR as a two-stage procedure between 2007 and 2009.
  
  
  RESULTS
  After a median follow-up of 42.6 (range: 36-80) months, none of our patients complained of symptoms of incontinence apart from one female patient with gas incontinence diagnosed preoperatively. There was no statistically significant difference in basal anal pressure, squeeze anal pressure, high pressure zone length or fecal continence assessed using the Fecal Incontinence Severity Index before and in follow-up months after the procedure. Postoperative morbidity consisted of one hematoma formation and one male patient complaining about sexual dysfunction until 6 months postoperatively. There was no evidence of locoregional recurrence.
  
  
  CONCLUSIONS
  Endoscopic posterior mesorectal resection in combination with TEM appears to be safe, feasible and with no impact on the basic anorectal functions in the 3-year follow-up.
authors.affiliation: 3 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Wałęga
authors.affiliation: 3 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Kenig
authors.affiliation: 3 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Richter
keywords: endoscopic posterior mesorectal resection; rectal cancer; transanal endoscopic microsurgery
references.citation: World J Surg. 2010 Jul;34(7):1604-8
references.pmid: 20174804
references.citation: Br J Surg. 1996 Jan;83(1):51-2
references.pmid: 8653363
references.citation: Gastrointest Cancer Res. 2009 May;3(3):105-14
references.pmid: 19626153
references.citation: World J Gastrointest Oncol. 2012 Apr 15;4(4):84-8
references.pmid: 22532882
references.citation: Br J Surg. 2008 Mar;95(3):375-80
references.pmid: 18278781
references.citation: Wideochir Inne Tech Maloinwazyjne. 2013 Sep;8(3):253-7
references.pmid: 24130643
references.citation: Surg Endosc. 2006 Apr;20(4):541-5
references.pmid: 16508812
references.citation: Dis Colon Rectum. 2006 Oct;49(10):1492-506; discussion 1500-5
references.pmid: 16897336
references.citation: Dis Colon Rectum. 1996 Oct;39(10):1116-21
references.pmid: 8831526
references.citation: Wideochir Inne Tech Maloinwazyjne. 2013 Sep;8(3):183-6
references.pmid: 24130630
references.citation: Dis Colon Rectum. 2010 Sep;53(9):1234-9
references.pmid: 20706065
references.citation: Surg Endosc. 2007 Jan;21(1):97-102
references.pmid: 17111281
references.citation: Br J Surg. 1992 Dec;79(12):1381-2
references.pmid: 1486447
references.citation: Langenbecks Arch Surg. 2007 Sep;392(5):567-71
references.pmid: 17636321
references.citation: J Clin Pathol. 2011 Dec;64(12):1073-7
references.pmid: 21821862
references.citation: Dis Colon Rectum. 2006 Jun;49(6):919-24
references.pmid: 16612534
references.citation: Br J Surg. 1996 Feb;83(2):211-3
references.pmid: 8689165
references.citation: Wideochir Inne Tech Maloinwazyjne. 2012 Jun;7(2):118-21
references.pmid: 23256013