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Neurochirurgie 10. November 2015

Transanal endoscopic microsurgery in treatment of small rectal T1 high-risk, T2 and T3 carcinomas combined with radiochemotherapy

Background: The present survey evaluates the value of TEM in the treatment of small T1 high-risk, T2 and T3 carcinomas in combination with neoadjuvant or adjuvant therapy or without radiochemotherapy.

Methods: In this retrospective survey, patient data from 86 patients suffering from T1 high-risk, T2 or T3 carcinoma was reviewed.

Results: Overall, Patients with T1 high-risk carcinoma showed a recurrence rate of 12.5 % (n = 16). The recurrence rate of T2 low-risk carcinomas was 11.1 % (n = 36), and of T2 high-risk carcinomas was 31.3 % (n = 17). Patients who had suffered a T3 low-risk carcinoma showed a recurrence rate of 0 % (n = 5). In the group of patients with T3 high-risk carcinomas, 16.7 % (n = 12) showed a recurrence.

Conclusions: An analysis of the different subgroups has shown that after successful downstaging with neoadjuvant radiochemotherapy, TEM is a curative treatment alternative for T2 low-risk carcinomas. It seems that the degree of downstaging has an effect on the prognosis with regard to the appearance of a local recurrence. The effect of downstaging of T2 low risk carcinomas can possibly be applied to T3 low-risk carcinomas. In the case of high-risk carcinomas, TEM can only be a treatment alternative for comorbid patients or a method for palliation.

M. Amann, J. Burghardt, C. Stratz, G. F. Buess, A. Modabber, European Surgery 5/2015

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