Recurrence after transanal excision of T1 rectal cancer

Should we be concerned?

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

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)711-719
Number of pages9
JournalDiseases of the Colon and Rectum
Volume48
Issue number4
DOIs
StatePublished - Apr 2005
Externally publishedYes

Fingerprint

Rectal Neoplasms
Recurrence
Neoplasms
Survival Rate
Villous Adenoma
Confidence Intervals
Salvage Therapy
Disease-Free Survival
Demography
Neoplasm Metastasis
Morbidity
Survival
Mortality
Therapeutics

Keywords

  • Local excision
  • Recurrence
  • T1 rectal tumor
  • Transanal excision

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Madbouly, K. M., Remzi, F. H., Erkek, B. A., Senagore, A. J., Baeslach, C. M., Khandwala, F., ... Lavery, I. C. (2005). Recurrence after transanal excision of T1 rectal cancer: Should we be concerned? Diseases of the Colon and Rectum, 48(4), 711-719. https://doi.org/10.1007/s10350-004-0666-0

Recurrence after transanal excision of T1 rectal cancer : Should we be concerned? / Madbouly, Khaled M.; Remzi, Feza H.; Erkek, Bulent A.; Senagore, Anthony J.; Baeslach, Christen M.; Khandwala, Farah; Fazio, Victor W.; Lavery, Ian C.

In: Diseases of the Colon and Rectum, Vol. 48, No. 4, 04.2005, p. 711-719.

Research output: Contribution to journalArticle

Madbouly, KM, Remzi, FH, Erkek, BA, Senagore, AJ, Baeslach, CM, Khandwala, F, Fazio, VW & Lavery, IC 2005, 'Recurrence after transanal excision of T1 rectal cancer: Should we be concerned?', Diseases of the Colon and Rectum, vol. 48, no. 4, pp. 711-719. https://doi.org/10.1007/s10350-004-0666-0
Madbouly KM, Remzi FH, Erkek BA, Senagore AJ, Baeslach CM, Khandwala F et al. Recurrence after transanal excision of T1 rectal cancer: Should we be concerned? Diseases of the Colon and Rectum. 2005 Apr;48(4):711-719. https://doi.org/10.1007/s10350-004-0666-0
Madbouly, Khaled M. ; Remzi, Feza H. ; Erkek, Bulent A. ; Senagore, Anthony J. ; Baeslach, Christen M. ; Khandwala, Farah ; Fazio, Victor W. ; Lavery, Ian C. / Recurrence after transanal excision of T1 rectal cancer : Should we be concerned?. In: Diseases of the Colon and Rectum. 2005 ; Vol. 48, No. 4. pp. 711-719.
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abstract = "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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T2 - Should we be concerned?

AU - Madbouly, Khaled M.

AU - Remzi, Feza H.

AU - Erkek, Bulent A.

AU - Senagore, Anthony J.

AU - Baeslach, Christen M.

AU - Khandwala, Farah

AU - Fazio, Victor W.

AU - Lavery, Ian C.

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N2 - 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.

AB - 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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KW - T1 rectal tumor

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