Local excision of rectal cancer with transanal endoscopic microsurgery (TEM).

Background: Local excision for T1 rectal cancers with Transanal Endoscopic Microsurgery (TEM) is an accepted standard of care. However for T2/T3 rectal cancers, the high local failure indicates that this is not a valid option. Materials and Methods: Between 1990 and 2000, 83 patients with rectal adenocarcinoma underwent complete full thickness local excision. The mean diameter of the tumor was 3.4±1.7 cm, 60% were located more than 5 cm from the anal verge; 43% of patients received radiation therapy (26 pre- and 10 postoperatively). Results: Postoperative complications occurred in 15 patients (18%); there were no postoperative deaths. Mean follow-up was 37 months (range 18-118). The pathological stage was: Tis 9, T1 39, T2 23, T3 12. The overall local recurrence rate was 0% for Tis, 13% for T1, 17% for T2 and 50% for T3. Recurrence was managed surgically in 65% and nonsurgically in 35% because of advanced disease or poor general condition. Overall 5-year survival rates were 100%, 92%, 75% and 69% for Tis, T1, T2 and T3, respectively. Conclusion: Local excision with TEM is effective for early (Tis,T1) rectal cancers. Patients with T2 tumors can be treated with preoperative chemoradiation and subsequently local resection. Patients with T3 should not be treated with local excision unless they are unable to tolerate more extensive surgery. Treatment of rectal tumors depends upon tumor characteristics such as size, location, pathological features and stage, as well as patient characteristics such as age, comorbidity and compliance. Although most patients with rectal cancer undergo anterior resection or abdominoperineal resection, a select group may be managed with local excision. These include patients with sessile tumors and Tis/T1 lesions. Local excision of locally advanced rectal tumors in association with chemoradiation has been reported with