Role of Endoluminal Surgery in the Treatment of Rectal Tumors

Abstract

Objective: To evaluate Indications and results of local excision in the management of sessile adenomas (AD) and selected adenocarcinomas (ADC) of the rectum.

Patients and methods: 119 patients have been treated with local excision, but 12 of them were not eligible for this analysis; among the study group (107 patients), 64 were males (58.9%) and 43 females (40.2%), with a mean age of 65+ 11 years (range 35-89); at pathological examination 42 patients were found to have an AD (39.2%) and 65 an ADC (60.8%). All tumours were staged by Transrectal Ultrasonography (TRUS). In the ADC group, 25 patients received preoperative chemoradiation and 12 patients postoperative radiotheraphy. Local excision was carried out using Transanal Endoscopic Microsurgery (TEM) or the Park's technique.

Results: Among the AD subgroup we had no operative mortality and a 11.9% hospital morbidity. We observed 3 recurrences (7.1%) during a mean follow up of 30.7 months ± 14.2. Six-year actuarial survival rate was 98%. in the ADC subgroup no operative mortality was observed, while 13 patients presented postoperative complications (21 %). Among complete procedures (74%, recurrence rate were 10% (Tis), 20% (pTl), 11.7%(pT2) and 66.6%(pT3) during a mean follow up of 46.7 months± 16,1. Overall recurrence rate was 20.8% (10/48. In T2 ADC preoperative chemoradiation significantly reduced the recurrence rote (0/13 vs 2/4 p<0.05).

Conclusion: Local excision represents a safe and appropriate approach for all adenomas and rectal cancers staged as Tis and Tl; chemoradiation may improve results in.T2 lesions, bmut long-term results are not available. In T3 cancer local excision has only a palliative purpose.