Progress report about the 1st Workshop on Local Excision of rectal cancer

To determine the significance of local excision (LE) of rectal cancer and discuss oncologic results, a1(st) Workshop on LE of rectal cancer was held at the Department of General und Abdominal Surgery, Johannes Gutenberg-University Mainz, Germany. The option of broadening the indication for local excision after neoadjuvant radiochemotherapy (nRCr) of rectal cancer was to be assessed. Local excision of "low risk" T1 carcinomas was rated as oncologically adequate therapy with good functional results and low complication rates. Transanal endoscopic microsurgical (TEM) resection was the preferrred technique. Pre-requisite for the achievement of low recurrence rates (5 %) is an RO resection with a safety margin of at least 1 mm (R <= 1 mm) without tu mor fragmentation, because otherwise possible tumor cell displacement and RX resection may not allow an assessment of the resection margin. "high risk" tumors or T 2 carcinomas were not considered an indication for local excision. To identify additional histological risk factors for the oncological outcome (sm-level, tumor budding, mucinous component, perineural infiltration, etc.) the initiation of a multi-center register study (LERC = local excision of rectal cancer) was suggested and is now in preparation. If the finding after TEM resection is not a "low risk" T 1 carcinoma, but a "high risk" situation or a T2 tumor, immediate reoperation is advised resulting in similar outcomes as compared to primary conventional surgery. A literature analysis of LE after neoadjuvant RCT of T 2/3 rectal cancers showed a local recurrence rate of 0% for ypT0 and of 5% for ypT1 findings (studies with small patient collectives and short follow-up periods). The lymph node status of T2/3carcinomas after nRCT is unclear. More advanced/primary not resectable tumors (T3/4) showed lymph node metastases in 5% forypTO and in 12% for ypT1 findings after nRCT, suggesting that for earlier T categories lower rates can be expected. On the basis of these favourable results a prospective multi-center study will be initiated. A study protocol will be established during the 2(nd) Workshop on LE of rectal cancer in Mainz.