title: Treatment of rectal cancer by transanal endoscopic microsurgery: experience with 425 patients.
abstract: OBJECTIVE
  To describe our experience in treating rectal cancer by transanal endoscopic microsurgery (TEM), report morbidity and mortality and oncological outcome.
  
  
  METHODS
  A total of 425 patients with rectal cancer (120 T1, 185 T2, 120 T3 lesions) were staged by digital rectal examination, rectoscopy, transanal endosonography, magnetic resonance imaging and/or computed tomography. Patients with T1-N0 lesions and favourable histological features underwent TEM immediately. Patients with preoperative stage T2-T3-N0 underwent preoperative high-dose radiotherapy; from 1997 those aged less than 70 years and in good general health also underwent preoperative chemotherapy. Patients with T2-T3-N0 lesions were restaged 30 d after radiotherapy and were then operated on 40-50 d after neoadjuvant therapy. The instrumentation designed by Buess was used for all procedures.
  
  
  RESULTS
  There were neither perioperative mortality nor intraoperative complications. Conversion to other surgical procedures was never required. Major complications (urethral lesions, perianal or retroperitoneal phlegmon and rectovaginal fistula) occurred in six (1.4%) patients and minor complications (partial suture line dehiscence, stool incontinence and rectal haemorrhage) in 42 (9.9%). Postoperative pain was minimal. Definitive histological examination of the 425 malignant lesions showed 80 (18.8%) pT0, 153 (36%) pT1, 151 (35.5%) pT2, and 41 (9.6%) pT3 lesions. Eighteen (4.2%) patients (ten pT2 and eight pT3) had a local recurrence and 16 (3.8%) had distant metastasis. Cancer-specific survival rates at the end of follow-up were 100% for pT1 patients (253 mo), 93% for pT2 patients (255 mo) and 89% for pT3 patients (239 mo).
  
  
  CONCLUSIONS
  TEM is a safe and effective procedure to treat rectal cancer in selected patients without evidence of nodal involvement. T2-T3 lesions require preoperative neoadjuvant therapy.
authors: Mario Guerrieri, Roberto Ghiselli, Giovanni Lezoche, Andrea Budassi, Maddalena Baldarelli, Department of General Surgery, Università Politecnica delle Marche, 60126 Ancona, Italy.
authors: Mario
authors: M
authors: Guerrieri
authors: Mario Guerrieri, Roberto Ghiselli, Giovanni Lezoche, Andrea Budassi, Maddalena Baldarelli, Department of General Surgery, Università Politecnica delle Marche, 60126 Ancona, Italy.
authors: Rosaria
authors: R
authors: Gesuita
authors: Mario Guerrieri, Roberto Ghiselli, Giovanni Lezoche, Andrea Budassi, Maddalena Baldarelli, Department of General Surgery, Università Politecnica delle Marche, 60126 Ancona, Italy.
authors: Roberto
authors: R
authors: Ghiselli
authors: Mario Guerrieri, Roberto Ghiselli, Giovanni Lezoche, Andrea Budassi, Maddalena Baldarelli, Department of General Surgery, Università Politecnica delle Marche, 60126 Ancona, Italy.
authors: Giovanni
authors: G
authors: Lezoche
authors: Mario Guerrieri, Roberto Ghiselli, Giovanni Lezoche, Andrea Budassi, Maddalena Baldarelli, Department of General Surgery, Università Politecnica delle Marche, 60126 Ancona, Italy.
authors: Andrea
authors: A
authors: Budassi
authors: Mario Guerrieri, Roberto Ghiselli, Giovanni Lezoche, Andrea Budassi, Maddalena Baldarelli, Department of General Surgery, Università Politecnica delle Marche, 60126 Ancona, Italy.
authors: Maddalena
authors: M
authors: Baldarelli
mesh_terms: D000368:Aged; D001003:Anal Canal; D017024:Chemotherapy, Adjuvant; D003952:Diagnostic Imaging / Q000379:methods; D051517:Digital Rectal Examination; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chemoradiotherapy; Downstaging; Local excision; Rectal cancer; Transanal endoscopic microsurgery