Modern management of T1 rectal cancer by TEM:a ten-year single-centre experience.

Aim Minimally-invasive, organ-sparing surgery has been used increasingly for early rectal cancer in recent years. However local recurrence remains a concern. This study presents a ten-year single-centre experience of recurrence after local excision for T1 rectal cancer. Method Data are collected prospectively on all patients undergoing local excision by transanal endoscopic microsurgery (TEM) in a single institution. Data covering a 10-year period were analysed. Results 192 patients underwent TEM for rectal cancer; 70 of these had T1 tumour in the TEM specimen and did not have pre-operative radiotherapy. Four were managed with completion surgery following TEM and a further six had radiotherapy, 60 underwent surveillance alone. Local recurrence occurred in six patients, three underwent salvage surgery. Estimated local recurrence at 3 years was 7.2% for the surveillance alone group. Conclusions Local recurrence rates were lower than previous studies. Better pre-operative assessment, more effective local excision surgery and post-operative radiotherapy may be contributory factors to a better-than-predicted outcome. Local excision should be offered as part of standard of care for T1 rectal cancer in the presence of good pre-operative selection and meticulous surveillance.</p