Top

Published in:

01-02-2012

Transanal endoscopic microsurgery for T1 rectal cancer: size matters!

Authors: Pascal G. Doornebosch, Eliane Zeestraten, Eelco J. R. de Graaf, Pleun Hermsen, Imro Dawson, Rob A. E. M. Tollenaar, Hans Morreau

Published in: Surgical Endoscopy | Issue 2/2012

Abstract

Background

Transanal endoscopic microsurgery (TEM) is considered a curative option for selected T1 rectal cancer. Although TEM is safe, local recurrence (LR) rates after TEM are unacceptably high. Evidence on selection criteria, however, is not abundant. To expand evidence on low- versus high-risk T1 rectal cancer with respect to LR, this study aimed to identify predictive histopathologic factors in a selected group of T1 rectal cancers treated with TEM only.

Methods

The study enrolled 62 patients for whom specimens of the primary tumor containing an invasive T1 carcinoma could be reevaluated. Tumors were scored according to predefined criteria, and analysis of predictive factors for locoregional failure was performed.

Result

Local recurrence rates at 3 years for tumors 3 cm in size or smaller were significantly lower than for tumors larger than 3 cm (16 vs. 39%; P < 0.03). Combining smaller tumors with submucosal invasion depth and budding led to identifying tumors that likely will not recur (3-year LR rates, 7 and 10%, respectively).

Conclusions

The findings showed that low- and high-risk criteria are too robust for identifying tumors at risk for LR. Tumor size alone or in combination with submucosal invasion depth or tumor budding appeared to be a significant predictive factor for locoregional failure after TEM for T1 rectal cancer.

Atkin WS, Cook CF, Cuzick J, Edwards R, Northover JMA, Wardle J (2002) Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial. Lancet 359:1291–1300PubMedCrossRef

You YN, Baxter NN, Stewart A, Nelson H (2007) Is the increasing rate of local excision for stage I rectal cancer in the United States justified? A nationwide cohort study from the National Cancer Database. Ann Surg 245:726–733PubMedCrossRef

Ptok H, Marusch F, Meyer F, Schubert D, Koeckerling F, Gastinger I, Lippert H (2007) Oncological outcome of local vs radical resection of low-risk pT1 rectal cancer. Arch Surg 142:649–655 (discussion 656)PubMedCrossRef

Paty PB, Nash GM, Baron P, Zakowski M, Minsky BD, Blumberg D, Nathanson DR, Guillem JG, Enker WE, Cohen AM, Wong WD (2002) Long-term results of local excision for rectal cancer. Ann Surg 236:522–529 (discussion 529–530)PubMedCrossRef

Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J (2000) Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 43:1064–1071 (discussion 1071–1064)PubMedCrossRef

Bentrem DJ, Okabe S, Wong WD, Guillem JG, Weiser MR, Temple LK, Ben-Porat LS, Minsky BD, Cohen AM, Paty PB (2005) T1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg 242:472–477 (discussion 477–479)PubMed

Endreseth BH, Myrvold HE, Romundstad P, Hestvik UE, Bjerkeset T, Wibe A (2005) Transanal excision vs major surgery for T1 rectal cancer. Dis Colon Rectum 48:1380–1388PubMedCrossRef

Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48:270–284PubMedCrossRef

Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999PubMedCrossRef

10.

De Graaf EJ, Doornebosch PG, Tollenaar RA, Meershoek-Klein KE, de Boer AC, Bekkering FC, van de Velde CJ (2009) Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention. Eur J Surg Oncol 35:1280–1285PubMedCrossRef

11.

Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguilar J (2002) Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum 45:875–879PubMedCrossRef

12.

Weiser MR, Landmann RG, Wong WD, Shia J, Guillem JG, Temple LK, Minsky BD, Cohen AM, Paty PB (2005) Surgical salvage of recurrent rectal cancer after transanal excision. Dis Colon Rectum 48:1169–1175PubMedCrossRef

13.

Doornebosch PG, Ferenschild FT, de Wilt JH, Dawson I, Tetteroo GW, de Graaf EJ (2010) Treatment of recurrence after transanal endoscopic microsurgery (TEM) for T1 rectal cancer. Dis Colon Rectum 53:1234–1239PubMedCrossRef

14.

Bach SP, Hill J, Monson JR, Simson JN, Lane L, Merrie A, Warren B, Mortensen NJ (2009) A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 96:280–290PubMedCrossRef

15.

Rothenberger DA, Garcia-Aguilar J (2000) Role of local excision in the treatment of rectal cancer. Semin Surg Oncol 19:367–375PubMedCrossRef

16.

Ueno H, Murphy J, Jass JR, Mochizuki H, Talbot IC (2002) Tumour “budding” as an index to estimate the potential of aggressiveness in rectal cancer. Histopathology 40:127–132PubMedCrossRef

17.

Kikuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, Uchida Y (1995) Management of early invasive colorectal cancer: risk of recurrence and clinical guidelines. Dis Colon Rectum 38:1286–1295PubMedCrossRef

18.

Masaki T, Matsuoka H, Sugiyama M, Abe N, Sakamoto A, Atomi Y (2006) Actual number of tumor budding as a new tool for the individualization of treatment of T1 colorectal carcinomas. J Gastroenterol Hepatol 21:1115–1121PubMedCrossRef

19.

Masaki T, Sugiyama M, Matsuoka H, Abe N, Izumisato Y, Goto A, Sakamoto A, Atomi Y (2003) Clinical utility of grading criteria for submucosal invasion in the prognosis of T1 colorectal carcinomas. J Gastroenterol 38:37–44PubMedCrossRef

20.

Rasheed S, Bowley DM, Aziz O, Tekkis PP, Sadat AE, Guenther T, Boello ML, McDonald PJ, Talbot IC, Northover JM (2008) Can depth of tumour invasion predict lymph node positivity in patients undergoing resection for early rectal cancer? A comparative study between T1 and T2 cancers. Colorectal Dis 10:231–238PubMedCrossRef

21.

Cooper HS (2007) Pathology of the endoscopically removed malignant colorectal polyp. Curr Diagn Pathol 13:423–437CrossRef

22.

NCCN Annual Conference (2010) http://www.nccn.org/professionals/physician_gls/PDF/rectal.pdf. Accessed on 7 December 2010

23.

Graham RA, Garnsey L, Jessup JM (1990) Local excision of rectal carcinoma. Am J Surg 160:306–312PubMedCrossRef

24.

Landmann RG, Wong WD, Hoepfl J, Shia J, Guillem JG, Temple LK, Paty PB, Weiser MR (2007) Limitations of early rectal cancer nodal staging may explain failure after local excision. Dis Colon Rectum 50:1520–1525PubMedCrossRef

25.

Mellgren A, Goldberg J, Rothenberger DA (2005) Local excision: some reality testing. Surg Oncol Clin North Am 14:183–196CrossRef

26.

Harris EI, Lewin DN, Wang HL, Lauwers GY, Srivastava A, Shyr Y, Shakhtour B, Revetta F, Washington MK (2008) Lymphovascular invasion in colorectal cancer: an interobserver variability study. Am J Surg Pathol 32:1816–1821PubMedCrossRef

27.

Costantini M, Sciallero S, Giannini A, Gatteschi B, Rinaldi P, Lanzanova G, Bonelli L, Casetti T, Bertinelli E, Giuliani O, Castiglione G, Mantellini P, Naldoni C, Bruzzi P (2003) Interobserver agreement in the histologic diagnosis of colorectal polyps: the experience of the multicenter adenoma colorectal study (SMAC). J Clin Epidemiol 56:209–214PubMedCrossRef

28.

Komuta K, Batts K, Jessurun J, Snover D, Garcia-Aguilar J, Rothenberger D, Madoff R (2004) Interobserver variability in the pathological assessment of malignant colorectal polyps. Br J Surg 91:1479–1484PubMedCrossRef

29.

Ono Y, Nakanishi Y, Ino Y, Niki T, Yamada T, Yoshimura K, Saikawa M, Nakajima T, Hirohashi S (1999) Clinocopathologic significance of laminin-5 gamma2 chain expression in squamous cell carcinoma of the tongue: immunohistochemical analysis of 67 lesions. Cancer 85:2315–2321PubMedCrossRef

30.

Moriya Y, Niki T, Yamada T, Matsuno Y, Kondo H, Hirohashi S (2001) Increased expression of laminin-5 and its prognostic significance in lung adenocarcinomas of small size: an immunohistochemical analysis of 102 cases. Cancer 91:1129–1141PubMedCrossRef

31.

Morodomi T, Isomoto H, Shirouzu K, Kakegawa K, Irie K, Morimatsu M (1989) An index for estimating the probability of lymph node metastasis in rectal cancers: lymph node metastasis and the histopathology of actively invasive regions of cancer. Cancer 63:539–543PubMedCrossRef

32.

Rutten HJ, den Dulk M, Lemmens V, van de Velde CJ, Marijnen CA (2008) Contreversies of total mesorectal excision for rectal cancer in elderly patients. Lancet Oncol 9:494–501PubMedCrossRef

Title: Transanal endoscopic microsurgery for T1 rectal cancer: size matters!
Authors: Pascal G. Doornebosch
Eliane Zeestraten
Eelco J. R. de Graaf
Pleun Hermsen
Imro Dawson
Rob A. E. M. Tollenaar
Hans Morreau
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 2/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-011-1918-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Transanal endoscopic microsurgery for T1 rectal cancer: size matters!

Abstract

Background

Methods

Result

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Result

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2012

Selective tissue elevation by pressure for endoscopic mucosal resection of colorectal adenoma: first clinical trial

Capnographic monitoring for carbon dioxide insufflation during endoscopic mucosal dissection: comparison of transcutaneous and end-tidal capnometers

Exploring the role of minimally invasive treatment strategies in early rectal cancer: the significance of functional outcome and quality of life

Stenting for malignant colorectal obstruction: a single-center experience with 101 patients

Changes in cuff pressure of endotracheal tube during laparoscopic and open abdominal surgery

Repeated transvaginal notes: is it possible?