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Transanale endoskopische Mikrochirurgie beim pT1-Low-risk-Rektumkarzinom

Zusammenhang zwischen Submukosainfiltrationstiefe und Lokalrezidivrate

Submucosal infiltration and local recurrence in pT1 low-risk rectal cancer treated by transanal endoscopic microsurgery

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Zusammenfassung

Hintergrund

Anhand der Langzeitverläufe von Patienten mit einem pT1-Low-risk-Rektumkarzinom wurde das Auftreten von Lokalrezidiven und der mögliche Zusammenhang mit der Tiefe der Submukosainfiltration analysiert.

Patienten und Methoden

40 Patienten mit einem pT1-Karzinom des mittleren und oberen Rektumdrittels wurden mittels transanaler endoskopischer Mikrochirurgie (TEM) lokal reseziert. Alle Karzinome entsprachen den Low-risk-Kriterien G1/G2 und wurden R0 reseziert. Die Follow-up-Quote betrug 100%, bei einer medianen Nachbeobachtungszeit von 5,4 Jahren.

Ergebnisse

Zwei Patienten (5%) entwickelten ein Lokalrezidiv nach 14 bzw. 18 Monaten, das, jeweils nach neoadjuvanter Radiochemotherapie, kurativ entfernt werden konnte. In der Primärhistologie lag in beiden Fällen eine tiefe Submukosainfiltration (sm3) vor. Ein Patient, primär sm2, ohne Lokalrezidiv entwickelte eine metachrone, singuläre Lebermetastase, die kurativ reseziert wurde. Das Risiko ein Lokalrezidiv zu entwickeln war für die sm3-Tumoren signifikant erhöht (sm1+sm2 vs. sm3, p=0,046).

Schlussfolgerung

Die transanale endoskopische Mikrochirurgie ist ein gutes Verfahren für pT1-Low-risk-Rektumkarzinome. Die tiefe Submukosainfiltration (sm3) erscheint als ein weiterer High-risk-Faktor für die Entwicklung eines Lokalrezidivs.

Abstract

Background

The association between submucosal infiltration and tumor recurrence was analyzed by long-term follow-up of patients with pT1 “low risk” rectal carcinoma.

Patients and methods

Forty patients with pT1 rectal cancer of the upper and middle rectum were treated by transanal endoscopic microsurgery. All carcinomas fulfilled the low-risk criteria, and were completely resected. No further treatment was carried out. Follow-up data were available for all 40 patients, with a median follow-up of 5.4 years.

Results

Two patients (5.0%) developed local tumor recurrence after 14 and 18 months, respectively, and had curative rectal resection after neoadjuvant radiochemotherapy. In the histology of the initial specimens, both patients had deep submucosal infiltration (sm3). Another patient, primarily sm2 without local recurrence, developed a metachronous singular liver metastasis which was curatively resected. The risk of developing a recurrent tumor was significant for sm3 carcinomas (sm1+sm2 vs sm3, P=0.046).

Conclusion

Transanal endoscopic microsurgery is an excellent method of treating low-risk pT1 carcinomas of the rectum. Deep submucosal infiltration (sm3) seems to be an additional high-risk factor for developing local recurrence.

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Danksagung

Wir danken Frau Prof. Dr. E. Bollschweiler für die statistische Aufbereitung der Patientendaten.

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Authors and Affiliations

  1. Klinik und Poliklinik für Visceral- und Gefäßchirurgie, Universität zu Köln

    H. Schäfer, F. Gasper & A. H. Hölscher

  2. Institut für Pathologie, Universität zu Köln

    S.E. Baldus

  3. Klinik und Poliklinik für Visceral- und Gefäßchirurgie, Universität zu Köln, Joseph-Stelzmann-Straße 9, 50924 , Köln

    H. Schäfer

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  1. H. Schäfer
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  2. S.E. Baldus
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  4. A. H. Hölscher
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Correspondence to H. Schäfer.

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Schäfer, H., Baldus, S., Gasper, F. et al. Transanale endoskopische Mikrochirurgie beim pT1-Low-risk-Rektumkarzinom. Chirurg 76, 379–384 (2005). https://doi.org/10.1007/s00104-004-0929-2

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  • DOI: https://doi.org/10.1007/s00104-004-0929-2

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