title: Endoluminal loco-regional resection by TEM after R1 endoscopic removal or recurrence of rectal tumors.
abstract: OBJECTIVE
  The aim of this study is to evaluate the safety and efficacy of endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM) after R1 endoscopic resection or local recurrence of early rectal cancer after operative endoscopy.
  
  
  METHODS
  Twenty patients with early rectal cancer were enrolled, including patients with incomplete endoscopic resection, or complete endoscopic resection of a tumor with unfavorable prognostic factors (group A, ten patients), and local recurrence after endoscopic removal (group B, ten patients). At admission, histology after endoscopic polypectomy was: TisR1(4), T1R0G3(1), T1R1(5) in group A, and TisR0(8), T1R0(2) in group B. All patients underwent ELRR by TEM with nucleotide-guided mesorectal excision (NGME).
  
  
  RESULTS
  Mean operative time was 150 minutes. Complications occurred in two patients (10%). Definitive histology was: moderate dysplasia(4), pT0N0(3), pTisN0(5), pT1N0(6), pT2N0(2). Mean number of lymph-nodes was 3.1. Mean follow-up was 79.5 months. All patients are alive and disease-free.
  
  
  CONCLUSIONS
  ELRR by TEM after R1 endoscopic resection of early rectal cancer or for local recurrence after operative endoscopy is safe and effective. It may be considered as a diagnostic procedure, as well as a curative treatment option, instead of a more invasive TME.
authors.affiliation: a Department of General Surgery , Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza, University , Viale del Policlinico 155 , 00186 Rome , Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Quaresima
authors.affiliation: a Department of General Surgery , Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza, University , Viale del Policlinico 155 , 00186 Rome , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Balla
authors.affiliation: a Department of General Surgery , Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza, University , Viale del Policlinico 155 , 00186 Rome , Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: D'Ambrosio
authors.affiliation: a Department of General Surgery , Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza, University , Viale del Policlinico 155 , 00186 Rome , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bruzzone
authors.affiliation: a Department of General Surgery , Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza, University , Viale del Policlinico 155 , 00186 Rome , Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ursi
authors.affiliation: a Department of General Surgery , Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza, University , Viale del Policlinico 155 , 00186 Rome , Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lezoche
authors.affiliation: a Department of General Surgery , Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza, University , Viale del Policlinico 155 , 00186 Rome , Italy.
authors.forename: Alessandro M
authors.initials: AM
authors.lastname: Paganini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D011351:Proctoscopy / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Rectal polyps; endoscopic mucosal resection (EMR); endoscopic submucosal dissection (ESD); recurrence; transanal endoscopic microsurgery (TEM)