Evaluating the effectiveness of transanal endoscopic microsurgery for the treatment of early rectal cancer in patients over 60 years old with high surgical risk.

This study evaluated the effectiveness of transanal endoscopic microsurgery (TEM) for the treatment of early rectal cancer (RC) in patients over 60 years old with high surgical risk. The data showed that TEM is a reliable and effective treatment option in high-risk patients over 60 years old.

Rectal cancer (RC) is one of the most common types of cancer worldwide. RC involves the final part of the large intestine (rectum). The first choice for treatment of RC is usually surgery. However, this surgery is associated with high rates of side effects. After surgery, 60% of patients experience a bowel disorder. This might affect body image and quality of life.

Transanal endoscopic microsurgery (TEM) is a less invasive procedure for the removal of early rectal tumors. A tube with a camera is inserted through the rectum and tumors are removed without the need for a surgical opening. This technique offers greater organ preservation and decreases the risk of further surgery. However, local recurrence (cancer coming back) and distant metastasis (cancer spread to distant organs) after surgery remain challenges for patients with a high-risk RC. It is important to evaluate the effectiveness and safety of TEM for the treatment of early RC in patients over 60 years old with high surgical risk.

This study involved 47 patients over 60 years old with early RC who underwent TEM. There were 27 patients with high-risk factors and 20 patients without high-risk factors.

The average survival rate without cancer worsening was 75.6% after 5 years. 69.6% of the patients in the high-risk group were alive without cancer worsening versus 83.3% of the patients in the non-high-risk group. This difference was not statistically significant.

The overall survival rate was 90.2% after 5 years. 87% of the patients in the high-risk group were alive versus 94.4% of the patients in the non-high-risk group. This difference was not statistically significant.

After 5 years, the recurrence and cancer spread rate was 18.4%. There was a slightly higher risk of recurrence and cancer spread risk in the high-risk group (23.8%) compared to the non-high-risk group (11.8%). 

This study concluded that TEM is a reliable and effective option for the treatment of early RC in high-risk patients over 60 years old.

This study looked back in time at medical records. The sample size was very small. This study only included patients treated at a single institution in China. Larger studies are needed to validate the conclusions of the study.