[Retrospective analysis of carcinomas of the rectum operated by TEM during one year at our institute].

Introduction: The very first TEM (transanal endoscopyc microsurgery) in Hungary was performed in our department by professor Attila Nagy in 1992. Up to August 2016, 1385 operation in total was performed with an average number of 60 per year., 992 operations were carried out for benign reasons and 393 cases for malignancies. We analyze the malignant cases operated by TEM in 2013.

Subjects And Methods: In 2013 we performed 121 TEM on 118 patients (in 3 cases twice). 70 patients had benign, 48 patients had malignant pathology. The average follow-up was 32 (12-39) month.We analyzed the cases retrospectively, presenting the history of each patient in detail. The pathological stages were the following: 8 in situ carcinomas, 14 T1, 12 T2, 9 T3 and 5 Tx. 17 patients received preoperative RCT, (4 ypT0, 2 ypT1, 3 ypT2, 8 ypT3).

Results: In the pTis group one patient was lost to follow up. Local recurrence was noted in 2 cases (14.28%), from which one was malignant. No distant metastasis was observed; DFS: 85.71%, OS: 100%. From the pT1 group one patient was lost to follow up after 4 month. Local recurrence was found in 2/13 cases (15.38%), distant metastases in 1 out of 13 (7.69%); DFS: 84.61%, OS: 84.61%. In the pT2 group 3 local recurrences was observed (27.2%). Distant metastases occurred in one patient (9.09%); DFS: 81.81%, OS: 81.81%. In the pT3 group 2/8 local recurrence (25%), and 3/8 (37.5%) distant metastasis was found, DFS: 62.5%,OS: 75%. 4 patient out of the 5 pTx cases showed complete pathological response after neoadjuvant RCT and one patient's histology turned out to be carcinoid. Downstaging was observed in 10 patients who received neoadjuvant RCT.

Conclusions: By a thorough discussion of each individual patient's history we would like to draw attention on the complexity of treatment of rectal malignancies with TEM and the need of personalized care. Firm conclusions cannot be drawn from our series because of the small number of the patients and the heterogeneity of the therapies. The establishment of a precise preoperative diagnostic algorithm and accurate histopathological staging is inevitable for the effective use of the TEM and TEM like techniques. The number of the patients eligible for TEM after neoadjuvant RCT does not depends only on bowel screening programme, but also on finding an accurate way to determine the responder-non-responder status for neoadjuvant treatment.