Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm: F09

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Aim:The indications and results of local excision of rectal lesions are currently under debate.Method:Rectal lesions treated by transanal endoscopic microsurgery (TEM) wereprospectively analysed to identify risk factors for recurrence.Results:Between 1993 and 2009, 107 patients were treated by TEM for an adenocarcinoma: 48 pT1, 43 pT2 and 16 pT3. The 5 year overall survival rate was100%, 87.6% and 58% for pT1, pT2 and pT3 respectively (P < 0.001). The 5 year disease-free survival rate was 93.8%, 80.1% and 42% for pT1, pT2 and pT3 respectively (P < 0.001). Recurrence among pT1 was 0% (0/27) in ‘low risk’ and 23.8% (5/21) in ‘high risk’ cancers (P < 0.05) Submucosal infiltration was a significant risk factor for recurrence: 0% sm1, 16.7% sm2 and 30% sm3. On univariate analysis pT stage, tumour grading and < 1 mm margin freedom were identified as positivepredictors. On multivariate analysis only < 1 mm margin freedom and a positive margin were risk factors.Conclusion:TEM is curative for ‘low risk’ early rectal malignancy. Preoperative assessment of the risk factors is crucial for optimal treatment.

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