EP16 - Local Excision of Rectal Cancer by Transanal Endoscopic Microsurgery (TEM) – Review of outcomes and completeness of surveillance

Abstract Aim To review outcomes and completeness of follow-up for patients undergoing TEM for rectal cancer. Method Retrospective review of outcomes of all TEM cancer operations performed by a single surgeon. Where completion surgery was not indicated, adherence to local surveillance protocol was assessed. Results 20 Patients underwent TEM for cancer from January 2014-March 2022. 55.0% (n=11) Had submucosal excision and 45.0% (n=9) full-thickness excision. 35.0% (n=7) Went on to have completion surgery, 40.0%(n=8) had surveillance only, 10.0% (n=2) received adjuvant treatment then underwent surveillance and 15.0% (n=3) declined further treatment/follow-up or were unfit. Histology was T1 in 75.0%(n=15), T2 in 20.0% (n=4) and T3 in 5.0% (n=1). Of T1 cancers 40.0% (n=6) received completion surgery, 46.7% (n=7) surveillance only and 13.3% (n=2) declined further treatment or were too unwell. Of T2 cancers 25.0% (n=1) received completion surgery, 50.0% (n=2) were considered high risk for surgery and underwent adjuvant treatment then surveillance and 25.0% (n=1) surveillance only. The patient with T3 cancer declined anything further. Overall recurrence during TEM surveillance was 30.0% (n=3). For T1 and T2 recurrence was 14.3% (n=1) and 66.7% (n=2) respectively. Two patients underwent salvage surgery, and one underwent palliative chemotherapy. Of 10 patients in surveillance after TEM, 80.0% (n=8) have currently received up to date follow-up 20.0% (n=2) have not, due to patient choice. Conclusion All patients undergoing surveillance have been offered time appropriate follow-up tests. In this sample all patients received timely and appropriate treatment.