695 Transanal endoscopic microsurgery in early rectal cancer

In the period from 8/89 to 1/94,355 rectal tumours were locally excised by TEM, 236 of them have been adenomas and 98 carcinomas. In the group of carcinomas, 53% preoperatively have been judged as adenomas (rectoscopy, histology, endosonography). In carcinomas, a full wall dissection or a segmental resection is always performed. The final histology showed the following tumour stages (number of reoperated patients): 54 (8) pT1, low risk and 2 (0) pT1 high risk; 25 (16) pT2, low risk and 2 (2) pT2 high risk; 13 (8) pT3 low risk and 2 (0) pT3 high risk. Patients with pT1 low risk carcinomas, resected in toto , patients treated with palliative intent, high risk patients and those who refused an open operation, were not reoperated. The more advanced tumour stages (pT1 high risk, pT2 and pT3) required another open intervention. Of the 34 reoperated, 3 showed a residual primary tumour (two in pT2 and one in pT3 carcinoma). In 15 reoperated patients, we could see lymph node metastases (only in pT2 and pT3 carcinomas). After a follow up period of 17 months, 2 of 46 patients with pT1 low risk carcinoma, 0 of 2 patients with pT1 high risk carcinema, 0 of 9 patients with only locally excised pT2 carcinomas and 1 of 7 patients with only locally excised pT3 tumour had developed a recurrence. The two patients with recurrence of pT1 low risk tumour, underwent a second procedure for cure. The zero mortality, the low morbidity rate and the oncological reliability of the TEM makes it the method of choice in the treatment of pT1 low risk rectal carcinoma.