[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-352899-105":59,"doc-detail-352899-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","which-prognostic-factors-for-recurrence-after-transanal-endoscopic-microsurgery-for-early-rectal-cancer","Which prognostic factors for recurrence after transanal endoscopic microsurgery for early rectal cancer?","","Transanal endoscopic microsurgery (TEM) permits minimally invasive local excision of rectal neoplasms, yet the long-term oncologic safety of pTis and pT1 lesions and the value of classical histopathological risk features remain debated. A retrospective cohort of 170 consecutive patients treated with en bloc, R0 full-thickness TEM for pTis/pT1 adenocarcinoma (1994–2025) evaluated Vienna classification and multiple pathological predictors. Independent DFS predictors included deeper submucosal invasion (sm2–3), high grade (G3), and lymphovascular invasion (LVI).",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/which-prognostic-factors-for-recurrence-after-transanal-endoscopic-microsurgery-for-early-rectal-cancer/352899/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/which-prognostic-factors-for-recurrence-after-transanal-endoscopic-microsurgery-for-early-rectal-cancer/352899.png","ImageObject",300,407,{"name":92,"@type":93},"Rizky","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-23","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":8},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the main clinical question addressed in this study?","Question",{"text":112,"@type":113},"Which prognostic factors predict recurrence after TEM for early rectal cancer (pTis and pT1 lesions).","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were recurrence-related outcomes assessed?",{"text":117,"@type":113},"Disease-free survival (DFS) and overall survival (OS) were estimated using Kaplan–Meier analysis and log-binomial regression.",{"name":119,"@type":110,"acceptedAnswer":120},"Which pathological factors independently predicted DFS recurrence in pT1 tumors?",{"text":121,"@type":113},"Submucosal invasion beyond sm1 (sm2–3), high grade (G3), and lymphovascular invasion (LVI) were independent predictors of DFS.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},352899,1790169435,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":8,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},962085564807,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Surgical Endoscopy (2026) 40:3729–3737  \n[https://doi.org/10.1007/s00464-026-12632-9](https://doi.org/10.1007/s00464-026-12632-9)  \nand Other Interventional Techniques  \nWhich prognostic factors for recurrence after transanal endoscopic microsurgery for early rectal cancer?  \nAlberto Arezzo1 · Carlo Alberto Ammirati1 · Giovanni Distefano1 · Michele Barbiero1 · Francesca Sbuelz1 · Roberto Passera2 · Mario Morino  \nReceived: 1 December 2025 / Accepted: 30 January 2026 / Published online: 18 February 2026 © The Author(s) 2026  \nAbstract  \nBackground Transanal endoscopic microsurgery (TEM) enables the local excision of rectal neoplasms with minimal invasiveness; however, the long-term oncologic safety for pTis and pT1 lesions, as well as the significance of traditional histopathological risk factors, remains controversial.  \nMethods A retrospective cohort of 170 consecutive patients undergoing en bloc, R0 full-thickness TEM for rectal pTis or pT1 adenocarcinoma between 1994 and 2025 at a single tertiary centre was analysed. Pathological review included Vienna classification, submucosal invasion (sm1 vs sm2–3), tumour grade (G1–2 vs G3), lymphovascular invasion (LVI), mucinoushistotype, tumour budding, perineural invasion (PNI), and tumour diameter (> 3 cm) . Patients with adverse features were recommended salvage radical surgery or adjuvant radiotherapy. Disease-free (DFS) and overall survival (OS) were estimated using Kaplan–Meier analysis and log-binomial regression.  \nResults The median age was 71 years (IQR, 62–77), and the median follow-up was 24 months (IQR, 24–53) . Lesion distribution was Vienna 4.2 (n = 21), Vienna 4.4 (n = 21), pT1sm1 (n = 48), pT1sm2 (n = 40), and pT1sm3 (n = 40) . All patients achieved R0 excision. No recurrences were observed in the Vienna 4.2/4.4 groups. For pT1 tumours, recurrence rates were 4.2%(sm1), 37.5%(sm2), and 20.0%(sm3) . On multivariate analysis, submucosal invasion (sm2–3; HR 5.67, p = 0.021), high grade (G3; HR 3.58, p = 0.004), and LVI (HR 3.58, p = 0.003) were independent predictors of DFS. Other factors were not significant. In OS analysis, older age (> = 71 years) and tumour diameter > 3 cm were associated with poorer survival, whereas classical high-risk pathological factors (sm2–3, G3, LVI) were not.  \nConclusion TEM affords excellent long-term disease control for Vienna 4.2/4.4 lesions. In pT1 adenocarcinoma, only submucosal invasion beyond sm1, high grade, and LVI independently predict recurrence, underscoring the need for risk-adapted, multidisciplinary management.  \nKeywords Transanal endoscopic microsurgery · TEM · Hermanek criteria · Rectal neoplasms · Local excision · Prognostic factors · Recurrence  \nTransanal endoscopic microsurgery (TEM) was developed between 1980 and 1983 by Gerhard Buess with the primary goal of avoiding radical surgery in patients affected by large  \nAlberto Arezzo and Carlo Alberto Ammirati have contributed equally as first authors.  \n* Alberto Arezzo alberto.arezzo@unito.it  \n1 Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy  \n2 Biostatistics Unit, Department of Medical Sciences, University of Turin, Turin, Italy  \nlaterally spreading adenomas [1] . This novel endoscopic technique, which provided a stable pneumorectum and highdefinition, magnified visualisation, allowed for the precise full-thickness excision of rectal lesions greater than 2 cm in diameter with clear margins.  \nDuring the initial clinical experience, Buess observed that approximately 10% of these large adenomas were found tobe malignant tumours limited to the submucosal layer—i.e. pathological T1 adenocarcinomas [2] . At that time, the prevailing oncological policy mandated a second-stage radical surgery with total mesorectal excision and regional lymphadenectomy in all cases with unexpected carcinoma. However, not all patients accepted such completion surgery.  \nIn a subsequent retrospective analysis published in 1992, Buess reported that","cbCailTMnAYbkWus","https://ap.wps.com/l/cbCailTMnAYbkWus","pdf",1055101,"English","# Abstract\n# Background\n# Methods\n## Pathological review and outcomes\n# Results\n# Conclusion","[{\"question\":\"What was the main clinical question addressed in this study?\",\"answer\":\"Which prognostic factors predict recurrence after TEM for early rectal cancer (pTis and pT1 lesions).\"},{\"question\":\"How were recurrence-related outcomes assessed?\",\"answer\":\"Disease-free survival (DFS) and overall survival (OS) were estimated using Kaplan–Meier analysis and log-binomial regression.\"},{\"question\":\"Which pathological factors independently predicted DFS recurrence in pT1 tumors?\",\"answer\":\"Submucosal invasion beyond sm1 (sm2–3), high grade (G3), and lymphovascular invasion (LVI) were independent predictors of DFS.\"}]","Which prognostic factors for recurrence after transanal endoscopic microsurgery for early rectal cancer? | PDF",1790101934,23]