Long-term outcomes of pT1 rectal cancer after transanal endoscopic surgery : again, a word of caution on high local recurrence - a cohort study
Serra-Aracil, Xavier (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Gener Jorge, Cristina (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Nonell, Anna (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Ferreres Piñas, Joan Carles (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Espina Perez, Beatriz (Institut de Recerca Sant Pau)
Casalots, Alex (Consorci del Laboratori Intercomarcal de L'Alt Penedés I El Garraf)
Caro, Aleidis (Hospital Universitari Joan XXIIII de Tarragona)

Data:	2026
Resum:	Recent evidence suggests that the local recurrence (LR) rate after local excision of pT1 rectal adenocarcinoma may be higher than previously estimated, particularly in large cohorts with extended follow-up. This study aimed to evaluate the LR rate and long-term oncological outcomes in patients with pT1 rectal adenocarcinoma treated with transanal endoscopic surgery (TES). Observational cohort study including 824 consecutive patients who underwent TES at a single tertiary center between 2004 and 2021. Among them, 104 patients (12. 6%) were diagnosed with pT1 rectal adenocarcinoma. Patients were excluded if they had received neoadjuvant or adjuvant chemoradiotherapy, had non-rectal tumors, a follow-up of less than 40 months, or were treated with surgical techniques other than TES. With a median follow-up of 91 months (IQR: 84), 17 patients (16. 3%) developed LR and 14 (13. 5%) developed distant recurrence. Five-year rectal cancer-specific and overall survival rates were 95% and 74%, respectively. Among the 88 patients without histopathological or surgical high-risk factors, 13 (14. 8%) experienced LR and 9 (10. 2%) distant recurrence. Their five-year disease-free and overall survival rates were 95% and 74%, Multivariate analysis identified flat-ulcerated morphology as the only independent predictor of LR (OR 6. 8; 95% CI 1. 5-30. 4; p = 0. 01). TES for pT1 rectal adenocarcinoma resulted in a 16. 3% overall LR rate, and 14. 8% among patients without known risk factors, emphasizing the need for improved patient selection and novel prognostic and therapeutic tools. These findings warrant confirmation in multicenter studies with standardized criteria and prolonged follow-up. The online version contains supplementary material available at 10. 1007/s00384-025-05038-x.
Ajuts:	Universitat Autònoma de Barcelona
Nota:	Altres ajuts: acords transformatius de la UAB
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Transanal endoscopic microsurgery (TEM) ; Early rectal cancer ; Local excision ; Local recurrence ; Prognosis of T1 rectal adenocarcinoma ; Oncological outcome ; TME
Publicat a:	International Journal of Colorectal Disease, Vol. 41 (January 2026) , art. 10, ISSN 1432-1262

DOI: 10.1007/s00384-025-05038-x
PMID: 41483165

13 p, 985.4 KB

13 p, 985.4 KB

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