1- radiotherapy and chemotherapy
2- surgery TME
3- watch
in case I do surgery if the patient is young and another case I watch if the patient do want the surgery or the old patients.
Kikuchi stage SM2 is associated with 8-10% risk of locoregional lymph node metastases and is therefore generally considered a high-risk early rectal cancer. I would therefore recommend TME surgery.
Talk to the patient and give him/her the option. 1 in 10 will have lymphnode involvement. But a TME is not a small procedure nor is the quality of life optimal afterwards. The well informed patient has something to say in this matter I would think.
I agree with Dr Jutten. Other factors to consider (apart from the 8-10% risk of lymph node metastases associated with sm2) are: presence/absence of lymphovascular invasion in the original pathology, clinical N-stage based on preoperative imaging (MRI and/or EUS), age, performance status, possibility of sphincter-preservation in case of TME.
I agree with the latest posts.
First review the specimen with the pathologist looking for clear margin, poor differenciated or lymphovascular invasion.
A tumor representing sm2 according to the Kikuchi Classification has run with about 10% lymph node involvment which means, a patient in this condition is under risk of locoregional recurence what Dr. Mehta said above. however. I think transanal approach is a considerable way to be done because we know postoperative complaints and complications occured after TME. I think the resection with clear circumferential negative margin done by one of the transanal approaches (TEM, TAMIS,TEO...) could be considered as the treatment.
On the other hand patologic features of specimen are also important that Dr. Mehta stated. The features associated with negative prognostic factors. I personally give an option which is definitive sugery to the patient and his/her relatives to make a desicion.
TEM is curative in the great majority of the patients with a similar T1 rectal cancer. Local recurrence is possible in 10-15% of rhe cases. A careful follow-up (every 3 months in the first 24 months for example) could allow a rempestive diagnosis of the recurrence. In the majority of these patients radio-chemotherpay and surgey is curative.
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