Introduction Local excision of rectal cancers by Endoscopic Microsurgery (TEM) has become accepted as a valid treatment modality for very early rectal carcinomas (stage T1). However its use in the treatment of more advanced carcinomas of stage T2 and above remains more controversial due to the higher rate of local recurrence principally from occult nodal metastases. There has been considerable interest in the use of TEM in combination with radiotherapy in these patients as an alternative to radical rectal resection. We present a review of 12 patients with T2 rectal cancers who have undergone the TEM procedure, 6 of whom had additional radiotherapy and 6 who did not either because they were not fit to undergo this or because they elected for subsequent radical surgery.
Method The records of all patient who had undergone a TEM procedure for rectal carcinoma at Royal Preston Hospital were reviewed and all those with T2 pathological staging identified. Their treatments and outcomes were recorded.
Results Out of the 12 patients in the study, 6 did not receive radiotherapy either because they elected for subsequent radical surgery (3 patients) or were unfit for further treatment and underwent close follow-up (3 patients).
In the radiotherapy group, 2 patients had pre-op Long-Course Chemo-radiotherapy (LCCRT) with a good partial response, 2 were included in the national TEM and Radiotherapy in Early Rectal cancer (TREC) trial and had pre-op Short Course radiotherapy (SCRT) and 2 had adjuvant LCCRT + Papillon contact radiotherapy following TEM.
Median follow-up was 20 months. Patients not undergoing radial surgery had 3 monthly MR and sigmoidoscopy for 1 year and 6 monthly MR and sigmoidoscopy for a further 2 years.
In the no-radiotherapy group, 1 of the 3 patients who underwent subsequent radical surgery had involved mesorectal lymph nodes and 1 of those undergoing close follow-up without radical surgery developed mesorectal nodal recurrence. In radiotherapy group 1 patient, in the TREC trial, elected for subsequent radical surgery and had no residual disease and 5 for close follow-up with no recurrences to date. There was no 90 day surgical mortality in either group.
Conclusion Whilst the numbers in the study where not sufficient for valid statistical comparison, the lack of any tumour recurrence in the group receiving radiotherapy does support the use of TEM with radiotherapy as a promising alternative treatment modality for stage T2 rectal carcinoma particularly in patients who are high risk for radical surgery, have a near-complete response to pre-op radiotherapy or are keen to avoid a permanent stoma.
Disclosure of interest None Declared.
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