A Heintz1, M Mörschel, T Junginger. 1. Department of General and Abdominal Surgery, Johannes Gutenberg-University of Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany.
Abstract
BACKGROUND: We compared the results of transanal endoscopic microsurgery and radical surgery in patients with T1 carcinomas of the rectum. METHODS: We performed a retrospective study (1985-96) to compare the results obtained in 103 patients with T1 rectal carcinomas (low-risk T1, n = 80; high-risk T1; n = 23) undergoing transanal endoscopic microsurgery and radical surgical therapy. RESULTS: The complication rate in patients undergoing local excision was 3.4% (two of 58); it was 18% (eight of 45) in the group treated with radical surgery. Two of 45 patients (3.8%) died after radical resection; there were no deaths after local excision. With regard to the actuarial 5-year survival rate, no difference was observed in the group with low-risk T1 carcinoma between patients treated with local excision (79%) and those who had radical resection (81%) (p = 0.72). In patients with high-risk T1 carcinoma, lymph node metastases were identified in four of 11 patients undergoing radical resection (36%). Four of 12 patients with high-risk T1 carcinoma treated by local excision developed recurrences, whereas none of the patients undergoing primary radical surgery had a recurrence. CONCLUSIONS: Transanal endoscopic microsurgery for the treatment of low-risk T1 carcinomas is associated with a significantly lower complication rate than radical surgical therapy. There is no difference in 5-year survival between local and radical surgical therapy in patients with low-risk T1 carcinoma.
BACKGROUND: We compared the results of transanal endoscopic microsurgery and radical surgery in patients with T1 carcinomas of the rectum. METHODS: We performed a retrospective study (1985-96) to compare the results obtained in 103 patients with T1 rectal carcinomas (low-risk T1, n = 80; high-risk T1; n = 23) undergoing transanal endoscopic microsurgery and radical surgical therapy. RESULTS: The complication rate in patients undergoing local excision was 3.4% (two of 58); it was 18% (eight of 45) in the group treated with radical surgery. Two of 45 patients (3.8%) died after radical resection; there were no deaths after local excision. With regard to the actuarial 5-year survival rate, no difference was observed in the group with low-risk T1 carcinoma between patients treated with local excision (79%) and those who had radical resection (81%) (p = 0.72). In patients with high-risk T1 carcinoma, lymph node metastases were identified in four of 11 patients undergoing radical resection (36%). Four of 12 patients with high-risk T1 carcinoma treated by local excision developed recurrences, whereas none of the patients undergoing primary radical surgery had a recurrence. CONCLUSIONS: Transanal endoscopic microsurgery for the treatment of low-risk T1 carcinomas is associated with a significantly lower complication rate than radical surgical therapy. There is no difference in 5-year survival between local and radical surgical therapy in patients with low-risk T1 carcinoma.