Is Tem an Option for Patients with T2-T3 Rectal Tumors?

Maria C Mora Pinzon, MD, Amanda B Francescatti, BA, Theodore J Saclarides, MD

Rush University Medical Center, Loyola University Medical Center,

INTRODUCTION: Transanal endoscopic microsurgery (TEM) is not recommended as the sole treatment of advanced tumors (pT2, T3). However, patient reluctance or the presence of prohibitive comorbid conditions may render radical surgery an unacceptable option. We report our experience using TEM and radiation/chemotherapy for T2 and T3 cancers and compare it with patients who receive either radical surgery or no further treatment after TEM.

METHODS AND PROCEDURES: Retrospective analysis of a prospectively collected database of all patients that underwent TEM between 1990 – May 2012 for a T2 or T3 rectal cancer at Rush University Medical Center.

RESULTS: Forty-eight patients were identified, mean age was 69.55 years (28 – 98). 68.8% (33/48) were male. Nineteen patients underwent TEM followed by radical surgery (Group 1), 17 patients received TEM plus chemoradiation therapy (Group 2), and 12 patients had no further treatment (Group 3). Patients in group 1 were significantly younger (p= 0.000). There was no difference in local recurrence rates when comparing Groups 1 and 2. There was no statistically significant difference in the overall recurrence rates among the groups (Chi X2=4.74 p = 0.09), although there was a trend towards lower distant recurrence rates in group 1. Recurrence results are shown in the table below:

Group 1
(Radical Surgery)
n=19
Group 2
(RT/Chemo)
n= 17
Group 3
(No further treatment)
n= 12
Chi Square p value
Local Recurrence 0 0 3 (27.3%) 10.48 0.005
Distant Recurrence

2 (10.5%)

4 (23.5%) 2 (18.2%) 1.08 0.58
Overall Recurrence 2 (10.5%) 4 (23%) 5 (45.5%) 4.74 0.093

Time to recurrence was 70.4 months in group 1, 68.3 months in group 2, and 25.3 months in group 3, (X2= 19.9 p = 0.000). Survival was worse for group 3 (no further treatment) (Chi Square= 14.088 p=0.001). Tumor size > 4 cm has 4.9 times risk of distant recurrence than a tumor size less than 4 cm. The average follow up time is 2.39 years (range 0.3 -7.4 years).

CONCLUSIONS: Although TEM is not recommended for patients with T2/T3 tumors our study suggests that TEM with neoadjuvant therapy offers local recurrence rates similar to those obtained by TEM followed by radical surgery, especially in patients with tumor size less than 4 cm. When no additional treatment is provided, local recurrence is more likely and time to recurrence is shorter.

Key words: rectal cancer, transanal endoscopic microsurgery, neoadjuvant, survival, locally advanced


Session: Poster Presentation

Program Number: P035

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