Features of Late Recurrence Following Transanal Local Excision for Early Rectal Cancer

BACKGROUND: Transanal local excision has recently received attention as an alternative to radical surgery for early rectal cancer. Recurrence usually occurs within 5 years after surgery, but recurrences later than this have also been reported. OBJECTIVE: The aim of this study was to investigate the incidence and risk factors of recurrence in patients who have early rectal cancer 10 years after transanal local excision. DESIGN: Patients with early rectal cancer who underwent transanal local excision from October 1994 to December 2010 were retrospectively reviewed. We reviewed the demographics and clinicopathologic features of primary lesions and analyzed the incidence and risk factors of recurrence. SETTINGS: This investigation was conducted at a tertiary university hospital. PATIENTS: A total of 295 patients who underwent transanal local excision for pTis (n = 155) or pT1 (n = 140) early rectal cancer were included in the analysis. INTERVENTION: Transanal local excision was performed for each patient to excise primary rectal lesions. MAIN OUTCOME MEASURES: The primary end point of this study was the incidence of recurrence, especially late recurrence. The secondary end point was risk factors for recurrence. RESULTS: The 10-year cumulative local recurrence rate was 6.7% in pTis and 18.0% in pT1 patients. The rate of late local recurrence was 2.8% in pTis and 3.7% in pT1 patients. There was no evidence of late systemic recurrence 5 years after transanal local excision. In pT1 patients, a higher risk of recurrence was associated with an invasion depth of sm3, the presence of lymphovascular invasion, and a positive resection margin. LIMITATION: The main limitation of this study is its retrospective nature. CONCLUSIONS: Late recurrence can occur in patients with early rectal cancer who have undergone transanal local excision. Transanal local excision can be performed in selective patients with biologically favorable tumors, and 10-year postoperative surveillance should be considered for these patients.