Endoscopic radical treatment in early rectal cancer

Abstract

Purpose: Standard radical treatment for early rectal cancer includes a removal of the tumour with total mesorectal excision. There are numerous new techniques for endoscopic treatment which could shift the strategy for obtaining the postoperative results.Material and methods: We report our radical endoscopic treatment of early rectal carcinoma by endoscopic submucosal dissection (ESD ). Forty-five patients with early-stage rectal cancer (carcinoma in situ, T1sm1 and T1sm2) were enrolled. All of them were staged by 3-D endorectal ultrasound. In 43 cases, the tumours were endoscopically removed. The postoperative results were analyzed and presented only. No oncological results were reported.Results: The mean lesion size was 31,0 mm (range, 19-82 mm), and the mean operating time was 86 min. (range, 48-131 min.). Forty-two lesions were resected en bloc with tumour-free margins with a successful rate of 97,33% (42/43). Three lesions were understaged or their localization in the rectum was not suitable for endoscopic treatment. The following complications were observed: perforation of the rectum in one patient (4%) treated conservatively, and major bleeding in four patients (10%) stopped by endoscopic hemostasis. Neither systematic complications, nor mortality were observed.Conclusion: ESD procedure for early-stage rectal cancers is safe and effective. It has the advantage of a shorter hospital recovery. The postoperative results are significantly better in comparison of radical surgical treatment such as transanal excision. The perioperative morbidity is of different kind and the postoperative period is shorter