Local excision of early rectal cancer: A multi-centre experience of transanal endoscopic microsurgery from the United Kingdom.

Background: Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail patients.

Aim: To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery (TEMS) approach carried out at three large cancer centers in the United Kingdom.

Methods: TEMS database was retrospectively reviewed to assess demographics, operative findings and post operative clinical and oncological outcomes. This is a retrospective review of the prospective databases, which included all patients operated with TEMS approach, for early rectal cancer (Node-negative T1-T2), selected T3 in unfit/frail patients.

Results: Two hundred and twenty-two patients underwent TEMS surgery. This included 144 males (64.9%) and 78 females (35.1%), Median age was 71 years. The median distance of the tumours from the anal verge 4.5 cm. Median tumour size was 2.6 cm. The most frequent operative position of the patient was lithotomy (32.3%), Full-thickness rectal wall excision was done in 204 patients. Median operating time was 90 minutes. Average blood loss was minimal. There were two 90-day mortalities. Complete excision of the tumour with free microscopic margins by > 1mm were accomplished in 171 patients (76.7%). Salvage total mesorectal excision was performed in 42 patients (19.8%). Median disease-free survival was 65 months (range: 3-146 months) (82.8%), and median overall survival was 59 months (0-146 months).

Conclusion: TEMS provides a promising option for early rectal cancers (Large adenomas-cT1/cT2N0), and selected therapy-responding cancers. Full-thickness complete excision of the tumour is mandatory to avoid jeopardising the oncological outcomes.