Management Of T2 N0 Rectal Tumors: Long-Term Randomized Study Comparing Transanal Endoscopic Microsurgery Vs Laparoscopic Resections
Emanuele Lezoche1, Mario Guerrieri2, Angelo De Sanctis2, Roberto Campagnacci2, Maddalena Baldarelli2, Giovanni Lezoche1, Silvana Perretta1; 1Dpt of Surgery Paride Stefanini, University La Sapienza, Roma, Italy; 2Dpt. of Surgery, Polytechnical University of Marche, Ancona, Italy
Aim: To assess the oncological results with a 5 years minimum follow-up of Transanal Endoscopic Microsurgery (TEM) and Laparoscopic Low Anterior Resection (LLAR) with total mesorectal excision after preoperative chemo radiation in the treatment of T2 N0 rectal cancer. Methods: Seventy patients (pts) staged at the admission as T2 N0, G1-2 rectal cancer with a tumour diameter lower than 3 cm and located within 6 cm from the anal verge were enrolled: 35 were randomized to TEM and 35 to LLAR. The pts of both groups were previously underwent high dose radiotherapy (overall administration of 5,040 cGy in 28 fractions over 5 weeks) combined with continuous infusion of 5-Flurouracil (200 mg/m2/day). Results: The advantages of TEM over the LLAR, consist in less surgical trauma and a more comfortable post operator period with minimum uneasiness for the patient, thanks to the negligible post-operator pain (sometimes totally absent in the medium-high localizations), minimum breathing dysfunctions, early mobility, fast regain of the gastrointestinal peristalsis, low morbidity rate (usually minor complications), 24-48 hours hospitalization and absence of surgical scars. At median follow-up of 68.3 months (60-108) in both arms 2 local recurrence (5.7%) were observed after TEM and 1 (2.9%) after LLAR (p=0.981). One distant metastasis (2.9%) occurred after TEM and 1 (2.9%) after LLAR. The cumulative survival probability was 0.971 for TEM and 0.943 for LLAR. Conclusion: Local control and survival rates in pts underwent TEM are comparable to those underwent LLAR. TEM appears to be an effective treatment of selected T2 carcinomas of the rectum.
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