1. North Tees University Hospital Audit of T1 Rectal Cancers September 2013 – August 2014 Nicola Maguire Teaching fellow General Surgery 12/09/2014

2. Aims Appraise the management of T1 rectal cancer within our local unit To ensure patients are being stratified according to risk and managed appropriately

3. Methods Retrospective audit of prospectively collected data MDT database searched for T1 rectal tumours Between September 2013 and August 2014 Management and outcome data collected from electronic records/case notes

4. Results 11 patients diagnosed with T1 rectal cancer 5 females, 6 males Mean age 66 years(range 51-88) 4 bowel screening patients, remainder referred as 2 week rule

5. Results

6. EMR 3 patients Histology showed adenocarcinoma ranging from a microscopic focus to 13mm Completely excised No further intervention

7. TREC trial 1 patient randomised to neo-adjuvant radiotherapy + TEMS TEMS converted to single incision laparoscopic anterior resection as resectoscope was unable to reach area Histopathology: 7mm, Grade 1, T1Sm3 adenocarcinoma within 37mm high grade TVA 0/19 nodes Completely excised

8. TEMS 2 patients underwent TEMS as definitive treatment 1 patient opted for radiotherapy following discussion regarding risk of recurrence PatientSize (mm) GradeStage after TEMS Lympho/ vascular invasion Completely excised Adjuvant therapy 1201pT1N0Sm1Yes None 2242pT1NxSm3Yes Radiotherapy

9. TEMS with subsequent radical surgery 2 patients underwent TEMS followed by radical surgery ( 1 anterior resection and 1 APER) PatientSize (mm) GradeStage after TEMS Lympho/ vascular invasion Residual tumour after RS LN status following RS 1272pT1NxSm1YesNo1/24 +ve 2202pT1N1Sm3YesNo1/20 +ve

10. Radical Surgery 3 patients went straight to radical surgery Preop staging Tumour Size (mm) GradePathological staging 1T2N1M031T1Sm1N0Lap anterior resection + ileostomy 2T1/T2N0M0123T1Sm2N1Lap anterior resection + ileostomy 3T2N0M0302T1Haggit4N0Lap APER

11. Conclusion Significant variation in management of T1 rectal cancer Potential for over/under treatment Require further studies to assess optimal management of these patients with early disease