In rectal cancer total mesorectal excision (TME) is the gold standard. However, driven by the aim to avoid major morbidity and stoma formation, local excision (LE), preferrably with transanal... Show moreIn rectal cancer total mesorectal excision (TME) is the gold standard. However, driven by the aim to avoid major morbidity and stoma formation, local excision (LE), preferrably with transanal endoscopic microsurgery (TEM), is considered a curative alternative in selected rectal cancer patients. In this thesis the role of TEM in T1 rectal cancer is studied. It was shown that compared to TME, TEM achieves comparable survival rates, however local recurrence rates are as high as 24%, despite a microscopic negative excision margin of at least 2 mm. These recurrences can be managed with radical salvage surgery, but survival in this subgroup of patients is limited, mainly due to distant metastases. Analysis on histopathological evaluation in those recurrent tumors could identify larger tumors at risk for a local recurrence. Accepted high-risk criteria could not be confirmed in our study. Another item in TEM is anorectal functioning postoperative. It was shown that TEM has no detrimental effect on anorectal functioning, as measured with validated questionnaires, and compared to TME leads to less defaction disorders. In the future, special focus of interest should be on identifying rectal cancer in presumed adenomas and on rectal sparing surgery for rectal cancer patients following neoadjuvant chemoradiotherapy. Show less
