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01.04.2005 | Original Contribution

Recurrence After Transanal Excision of T1 Rectal Cancer: Should We Be Concerned?

verfasst von: Khaled M. Madbouly, M.D., Feza H. Remzi, M.D., Bulent A. Erkek, M.D., Anthony J. Senagore, M.D., Christen M. Baeslach, M.S., Farah Khandwala, M.S., Victor W. Fazio, M.B., M.S., Ian C. Lavery, M.B.B.S.

Erschienen in: Diseases of the Colon & Rectum | Ausgabe 4/2005

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PURPOSE

Transanal excision is an appealing treatment for low rectal cancers because of its low morbidity, mortality, and better functional results than transabdominal procedures. However, controversy exists about whether it compromises the potential for cure. Several, recent reports of high recurrence rates after local excision prompted us to review our results of transanal excision alone in patients with T1 rectal cancers.

METHODS

All patients with T1 low rectal cancer undergoing local excision alone between 1980 through 1998 were reviewed for local recurrence, distant metastasis, disease-free interval, results of salvage surgery, and overall and disease-free survival. Demographics, tumor size, distance from anal verge, and preoperative endoluminal ultrasound results also were recorded. Patients with poorly differentiated tumors, perineural or lymphovascular invasion, or with mucinous component were excluded.

RESULTS

Fifty-two patients underwent transanal excision during the study period. Five-year recurrence was estimated to be 29.38 percent (95 percent confidence interval, 15.39–43.48). For 52 patients, five-year, cancer-specific and overall survival rates were 89 and 75 percent respectively. Fourteen of 15 patients with recurrence underwent salvage treatment with 56.2 percent (95 percent confidence interval, 35.2–90) five-year survival rate. Gender, preoperative staging by endorectal ultrasound, distance from the anal verge, tumor size, location, and T1 status discovered after transanal excision of a villous adenoma did not influence local recurrence or tumor-specific survival.

CONCLUSIONS

Transanal excision for T1 rectal tumors with low-grade malignancy has a high rate of recurrence. Although overall cancer survival rates might be regarded as satisfactory, this high recurrence and low salvage rate raises the issue about the role of transanal excision alone for early rectal cancer and the possible need for adjuvant therapy or increased role of resective surgery.
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Metadaten
Titel
Recurrence After Transanal Excision of T1 Rectal Cancer: Should We Be Concerned?
verfasst von
Khaled M. Madbouly, M.D.
Feza H. Remzi, M.D.
Bulent A. Erkek, M.D.
Anthony J. Senagore, M.D.
Christen M. Baeslach, M.S.
Farah Khandwala, M.S.
Victor W. Fazio, M.B., M.S.
Ian C. Lavery, M.B.B.S.
Publikationsdatum
01.04.2005
Erschienen in
Diseases of the Colon & Rectum / Ausgabe 4/2005
Print ISSN: 0012-3706
Elektronische ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-004-0666-0

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CME: 2 Punkte

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PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.