title: Long-term results of transanal endoscopic microsurgery after endoscopic polypectomy of malignant rectal adenoma.
abstract: BACKGROUND
  There is no consensus on the treatment and prognosis of malignant rectal polyps. The aim of the present study was to determine the role of transanal endoscopic microsurgery (TEM) after endoscopic complete polypectomy of malignant rectal adenomas with long-term follow-up.
  
  
  METHODS
  Of 105 patients with pT1 rectal carcinoma in 32 patients TEM followed complete endoscopic polypectomy while 73 had primary TEM. Local recurrence (LR), distant metastasis, overall and cancer-specific survival were determined by the Kaplan-Meier method.
  
  
  RESULTS
  Median follow-up was 9.1 years. In 32 patients with TEM following complete polypectomy no residual cancer was found. LR occurred in 3/28 (11%) patients with low-risk carcinoma (pT1 G1/2/X, L0/X, R0) and in 1/4 (25%) with high-risk carcinoma (pT1 G3/4 or L1). After primary TEM with complete resection (minimal distance >1 mm) LR occurred in 6/60 (10%) with low-risk carcinoma. After incomplete TEM resection (minimal distance ≤1 mm) LR occurred in 3/8 (38%) patients with low-risk and in 1/5 (20%) patients with high-risk carcinoma. Grading was the only significant risk factor for LR after endoscopic polypectomy followed by TEM (p = 0.002). At all outcomes did not differ between postpolypectomy TEM and primary TEM.
  
  
  CONCLUSIONS
  Patients with malignant rectal polyps removed by endoscopic polypectomy have a substantial risk of LR even if TEM of polyp site is cancer free. Risk of LR depends on tumor characteristics. In low-risk carcinoma long-term follow-up is necessary. The high LR rate in patients with high-risk rectal carcinoma restricts the use of TEM alone.
authors.affiliation: Department of General and Abdominal Surgery, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany. Junginger@uni-mainz.de.
authors.forename: T
authors.initials: T
authors.lastname: Junginger
authors.affiliation: Department of General and Abdominal Surgery, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Goenner
authors.affiliation: Department of General, Visceral and Vascular Surgery, Catholic Hospital, Mainz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hitzler
authors.affiliation: Department of Heart, Chest and Vascular Surgery, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: T T
authors.initials: TT
authors.lastname: Trinh
authors.affiliation: Department of General, Visceral and Vascular Surgery, Catholic Hospital, Mainz, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Heintz
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Blettner
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Wollschlaeger
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D002277:Carcinoma / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D011127:Polyps / Q000601:surgery*; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013995:Time; D000067369:Transanal Endoscopic Microsurgery / Q000379:methods*; D016896:Treatment Outcome
keywords: Endoscopic polypectomy; Malignant rectal polyp; Prognosis; Transanal endoscopic microsurgery