Risk of recurrence following transanal endoscopic microsurgery without neoadjuvant or adjuvant treatment in T2 rectal cancer

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-03-13 DOI:10.1016/j.ejso.2025.109974

Erik Wetterholm, Carl-Fredrik Rönnow, Henrik Thorlacius

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引用次数: 0

Abstract

Background

Transanal endoscopic microsurgery (TEM) is only curative treatment for T1 rectal cancer with low-risk features. In T2 cancer, TEM is not recommended but could be used as a palliative procedure and/or in patients unfit for surgery. Few studies exist investigating recurrence after TEM for T2 rectal cancer.

Method

Retrospective, population-based study using the Swedish Colorectal Cancer Registry. Included patients had T2 rectal adenocarcinoma treated with TEM or surgery without neoadjuvant or adjuvant therapy between 2009 and 2021. Patients lost to follow-up, with syn/metachronous tumours or unknown recurrence status were excluded. Patient characteristics, perioperative morbidity, local and distant recurrence were compared.

Results

63 patients treated with TEM and 894 with surgery. Median age was 81 and 70 (p < 0.01). 59 % and 23 % respectively were ASA III-IV (p < 0.01). TEM tumours were more distal, 37 % vs 16 % in the lower third of the rectum (p < 0.01). There were no severe complications after TEM compared to 6 % following surgery (p = 0.04). 5-year local recurrence was 33 % after TEM and 2 % after surgery (HR = 25.58, (p < 0.01). 5-year distant recurrence rate was 9 % after TEM and 7 % after surgery (HR = 0.49, (p = 0.27). Mean time to local recurrence was 16 months after TEM, 34 months after surgery, time to distant recurrence 22 months after both.

Conclusion

TEM for T2 rectal cancer has high risk of local recurrence and cannot be recommended when intent is curative. TEM could be an option for patients unfit for surgery.

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背景经肛门内窥镜显微手术（TEM）是唯一能治愈低风险 T1 直肠癌的治疗方法。对于 T2 直肠癌，不推荐使用 TEM，但可作为姑息性手术和/或用于不适合手术的患者。很少有研究调查 T2 直肠癌 TEM 术后的复发情况。2009年至2021年间，T2直肠腺癌患者接受了TEM或手术治疗，但未接受新辅助或辅助治疗。不包括失去随访、合并/转移性肿瘤或复发状况不明的患者。结果63名患者接受了TEM治疗，894名患者接受了手术治疗。中位年龄分别为 81 岁和 70 岁（P< 0.01）。59%和23%的患者属于ASA III-IV级（P< 0.01）。TEM肿瘤更远，37%和16%的肿瘤位于直肠下三分之一处（p <0.01）。TEM术后无严重并发症，而手术后为6%（P = 0.04）。TEM术后5年局部复发率为33%，手术后为2%（HR = 25.58，（P = 0.01）。TEM术后5年远处复发率为9%，手术后为7%（HR = 0.49，（P = 0.27）。TEM术后局部复发的平均时间为16个月，手术后为34个月，两者术后远处复发的平均时间均为22个月。对于不适合手术的患者，TEM 不失为一种选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.