Objective:

To determine if recurrence rates in T1 rectal cancer patients differ between transanal endoscopic microsurgery (TEM) and surgical resection, highlighting the significance of this comparison across risk groups.

Key Findings:

• TEM is associated with higher local recurrence rates compared to surgical resection in T1 rectal cancer patients, indicating a need for careful treatment selection.
• Recurrence rates were analyzed across high and low-risk classifications as per ESGE guidelines, emphasizing the importance of risk stratification.
• Current guidelines focus on the risk of lymph node metastases rather than recurrence, which may not reflect the most clinically relevant outcomes.

Interpretation:

The study highlights the need for careful consideration of recurrence rates when choosing between TEM and surgical resection for T1 rectal cancer, suggesting a potential shift in treatment guidelines.

Limitations:

• The study did not include tumor budding in risk categorization due to lack of data, which may affect the accuracy of risk assessment.
• Potential confounding factors may not have been fully accounted for, introducing bias in the findings.

Conclusion:

The findings suggest that TEM may not be a suitable definitive treatment for T1 rectal cancer due to increased recurrence rates, warranting further research to inform clinical guidelines.