title: Features of Late Recurrence Following Transanal Local Excision for Early Rectal Cancer.
abstract: BACKGROUND
  Transanal local excision has recently received attention as an alternative to radical surgery for early rectal cancer. Recurrence usually occurs within 5 years after surgery, but recurrences later than this have also been reported.
  
  
  OBJECTIVE
  The aim of this study was to investigate the incidence and risk factors of recurrence in patients who have early rectal cancer 10 years after transanal local excision.
  
  
  METHODS
  Patients with early rectal cancer who underwent transanal local excision from October 1994 to December 2010 were retrospectively reviewed. We reviewed the demographics and clinicopathologic features of primary lesions and analyzed the incidence and risk factors of recurrence.
  
  
  METHODS
  This investigation was conducted at a tertiary university hospital.
  
  
  METHODS
  A total of 295 patients who underwent transanal local excision for pTis (n = 155) or pT1 (n = 140) early rectal cancer were included in the analysis.
  
  
  METHODS
  Transanal local excision was performed for each patient to excise primary rectal lesions.
  
  
  METHODS
  The primary end point of this study was the incidence of recurrence, especially late recurrence. The secondary end point was risk factors for recurrence.
  
  
  RESULTS
  The 10-year cumulative local recurrence rate was 6.7% in pTis and 18.0% in pT1 patients. The rate of late local recurrence was 2.8% in pTis and 3.7% in pT1 patients. There was no evidence of late systemic recurrence 5 years after transanal local excision. In pT1 patients, a higher risk of recurrence was associated with an invasion depth of sm3, the presence of lymphovascular invasion, and a positive resection margin.
  
  
  CONCLUSIONS
  The main limitation of this study is its retrospective nature.
  
  
  CONCLUSIONS
  Late recurrence can occur in patients with early rectal cancer who have undergone transanal local excision. Transanal local excision can be performed in selective patients with biologically favorable tumors, and 10-year postoperative surveillance should be considered for these patients.
authors.affiliation: 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 2 Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea 3 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 4 Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea 5 Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea 6 Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
authors.forename: Bo Young
authors.initials: BY
authors.lastname: Oh
authors.forename: Hae-Ran
authors.initials: HR
authors.lastname: Yun
authors.forename: Seok Hyung
authors.initials: SH
authors.lastname: Kim
authors.forename: Seong Hyeon
authors.initials: SH
authors.lastname: Yun
authors.forename: Hee Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Woo Yong
authors.initials: WY
authors.lastname: Lee
authors.forename: Ho-Kyung
authors.initials: HK
authors.lastname: Chun
authors.forename: Yong Beom
authors.initials: YB
authors.lastname: Cho
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures; D061345:Early Medical Intervention; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D011351:Proctoscopy; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome