Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum

BACKGROUND

We compared the results of transanal endoscopic microsurgery and radical surgery in patients with T1 carcinomas of the rectum.

METHODS

We performed a retrospective study (1985-96) to compare the results obtained in 103 patients with T1 rectal carcinomas (low-risk T1, n = 80; high-risk T1; n = 23) undergoing transanal endoscopic microsurgery and radical surgical therapy.

RESULTS

The complication rate in patients undergoing local excision was 3.4% (two of 58); it was 18% (eight of 45) in the group treated with radical surgery. Two of 45 patients (3.8%) died after radical resection; there were no deaths after local excision. With regard to the actuarial 5-year survival rate, no difference was observed in the group with low-risk T1 carcinoma between patients treated with local excision (79%) and those who had radical resection (81%) (p = 0.72). In patients with high-risk T1 carcinoma, lymph node metastases were identified in four of 11 patients undergoing radical resection (36%). Four of 12 patients with high-risk T1 carcinoma treated by local excision developed recurrences, whereas none of the patients undergoing primary radical surgery had a recurrence.

CONCLUSIONS

Transanal endoscopic microsurgery for the treatment of low-risk T1 carcinomas is associated with a significantly lower complication rate than radical surgical therapy. There is no difference in 5-year survival between local and radical surgical therapy in patients with low-risk T1 carcinoma.