National Early Rectal Cancer Treatment Revisited.
BACKGROUND
Treatment of early stage rectal cancer has excellent oncological results. To reduce treatment-related mortality and morbidity and improve functional results, a focus on local resections is increasingly important.


OBJECTIVE
The purpose of this study was to compare outcomes after transanal endoscopic microsurgery and total mesorectal excision for early stage rectal cancer (T1 + T2) in Norway.


METHODS
This was an observational study based on prospective data from the Norwegian Colorectal Cancer Registry.


METHODS
The study was conducted as a national, population-based study.


METHODS
All 543 patients with T1 and 1593 patients with T2 rectal cancer without distant metastases that was treated by transanal endoscopic microsurgery or total mesorectal excision without radiochemotherapy during 2000-2009 were included.


METHODS
The primary outcomes were 5-year relative survival and 5-year local recurrence rate.


RESULTS
Among 543 patients with T1 cancer, the 5-year overall survival rate was 65.3% after transanal endoscopic microsurgery versus 81.5% after total mesorectal excision (p = 0.012). Adjusted for age and sex there was no excess mortality for transanal endoscopic microsurgery (HR = 1.28 (95% CI, 0.8-1.9); p = 0.22). The 5-year relative survival rate was 96.8% after transanal endoscopic microsurgery versus 98.2% after total mesorectal excision (p = 0.603), and the 5-year local recurrence rate was 14.5% versus 1.4% (p < 0.001). Among 1593 patients with T2 cancer, 5-year overall survival was 42.1% versus 76.1% (p < 0.001), 5-year relative survival was 65.4% versus 93.9% (p < 0.001), and 5 year local recurrence rate was 11.4% versus 4.4% in the 2 groups.


CONCLUSIONS
The study is limited by its observational design and that the 2 groups were different according to patient and tumor characteristics. Another limitation was the low number of transanal endoscopic microsurgery procedures.


CONCLUSIONS
Transanal endoscopic microsurgery had comparable 5-year relative survival to total mesorectal excision in T1 rectal cancer but inferior 5-year relative survival in T2 rectal cancer. Transanal endoscopic microsurgery was associated with higher local recurrence rates for both T1 and T2 tumors.
1 Department of Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway 2 Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway 3 Institute of Clinical Medicine, University of Oslo, Oslo, Norway 4 Department of Gastrointestinal Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway 5 Centre for Cancer Biomedicine, Faculty of Medicine, University of Oslo, Oslo, Norway 6 K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norway 7 Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
Tore
T
Stornes
Arne
A
Wibe
Arild
A
Nesbakken
Tor Å
TÅ
Myklebust
Birger H
BH
Endreseth
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D000067369:Transanal Endoscopic Microsurgery; D016896:Treatment Outcome