Preoperative chemoradiotherapy affects postoperative outcomes and functional results in patients treated with transanal endoscopic microsurgery for rectal neoplasms

Rizzo, Gianluca; Pafundi, Donato Paolo; Sionne, Francesco; D’Agostino, Luca; Pietricola, Giulia; Gambacorta, Maria Antonietta; Valentini, Vincenzo; Coco, Claudio

doi:10.1007/s10151-020-02394-4

Cited by 14 publications

(11 citation statements)

References 58 publications

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“…The downside of conducting routine LE is that some reports have shown a higher complication rate compared to LE without preceding radiotherapy, although in the present study only 8% of patients had Clavien-Dindo > 2 complications. Additionally, worse functional outcomes of LE after radiotherapy have been reported [19][20][21][22][23]. As the majority of patients with a clinical complete or near-complete response have no residual tumor, they will gain no benefit from routine LE, while increasing their chances of anorectal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Role of Local Excision for Suspected Regrowth in a Watch and Wait Strategy for Rectal Cancer

Geubels

Meyer²,

Westreenen³

et al. 2022

Cancers

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Rectal cancer patients with a clinical complete response to neoadjuvant (chemo)radiation are eligible for Watch and Wait (W&W). For local regrowth, total mesorectal excision (TME) is considered the standard of care. This study evaluated local excision (LE) for suspected local regrowth. From 591 patients prospectively entered into a national W&W registry, 77 patients with LE for regrowth were included. Outcomes analyzed included histopathologic findings, locoregional recurrence, long-term organ preservation, and colostomy-free and overall survival. In total, 27/77 patients underwent early LE (<6 months after neoadjuvant radiotherapy) and 50/77 underwent late LE (≥6 months). Median follow-up was 53 (39–69) months. In 28/77 patients the LE specimen was histopathologically classified as ypT0 (including 9 adenomas); 11/77 were ypT1, and 38/77 were ypT2–3. After LE, 13/77 patients with ypT2–3 and/or irradical resection underwent completion TME. Subsequently, 14/64 patients without completion TME developed locoregional recurrence, and were successfully treated with salvage TME. Another 8/77 patients developed distant metastases. At 5 years, overall organ preservation was 63%, colostomy-free survival was 68%, and overall survival was 96%. There were no differences in outcomes between early or late LE. In W&W for rectal cancer, LE can be considered as an alternative to TME for suspected regrowth in selected patients who wish to preserve their rectum or avoid colostomy in distal rectal cancer.

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Section: Discussionmentioning

confidence: 99%

Role of Local Excision for Suspected Regrowth in a Watch and Wait Strategy for Rectal Cancer

Geubels

Meyer²,

Westreenen³

et al. 2022

Cancers

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“…In our recent experience, we recorded a significantly higher rate of suture line dehiscence in irradiated patients who underwent TEM than in nonirradiated patients who underwent TEM. 40 In the post hoc analysis of the GRECCAR 2 trial, which excluded patients treated by local excision plus completion TME, the rate of major morbidity, both early and late, after local excision (6% vs 10%) and after TME (6% vs 17%) was not significantly different. 38…”

Section: Discussionmentioning

confidence: 99%

Transanal Endoscopic Microsurgery Versus Total Mesorectal Excision in ypT0-1 Rectal Cancer After Preoperative Radiochemotherapy: Postoperative Morbidity, Functional Results, and Long-term Oncologic Outcome

Rizzo

Pafundi

Sionne

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND:In patients with locally advanced extraperitoneal rectal cancer, a multidisciplinary approach represents the standard treatment. However, considering the favorable prognosis in patients with major or complete response, radical surgery might represent overtreatment. OBJECTIVE:This study aimed to evaluate postoperative short-term morbidity, functional outcome, and oncologic long-term outcome in patients with rectal cancer treated with local excision by transanal endoscopic microsurgery or radical surgery and to determine who achieved a complete or major pathological response (ypT0-1) after neoadjuvant treatment. DESIGN:This was a retrospective study. SETTING:The study was conducted at a single center.PATIENTS: Patients who had received neoadjuvant treatment by local excision with a major or complete pathological response at histological examination (transanal endoscopic microsurgery group) were compared to patients treated by radical surgery with the same pathological response (total mesorectal excision group). INTERVENTIONS:The interventions included local excision by transanal endoscopic microsurgery and radical surgery with total mesorectal excision. MAIN OUTCOME MEASURES:Postoperative short-term morbidity, functional outcome 1 year after surgery, and oncologic long-term outcome were measured.RESULTS: Ninety-three patients were included in the study (35 in the transanal endoscopic microsurgery group and 58 in the mesorectal excision group). In the total mesorectal excision group, a sphincter-saving approach was possible in 89.7% (vs 100%; p = 0.049); a protective temporary stoma was necessary in 74.1% of radical procedures (vs 0%; p < 0.001), and 13.8% of these became permanent. Short-term postoperative morbidity was lower after local excision (14.3% vs 46.6%; p = 0.002). One year after surgery, the transanal endoscopic microsurgery group recorded better evacuation and continence function than the total mesorectal excision group. Oncologic outcome was similar between the groups.

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“…Khoury et al [112] found that continence can be also affected by repeated TEM procedures, as the result of multiple anal sphincter complex traumas. There are very few available studies that included patients who underwent chemoradiotherapy before TEM [35,64,110,113] and TAMIS [108], hence no conclusive data are available, although worsening functional outcomes have been reported in this group of patients as compared with those who underwent transanal surgery alone [35,110,113]. A possible explanation for worse results in irradiated patients can be postulated due to radiotherapy impairment of muscles and nerve fiber integrity and reduced rectal wall elasticity [114,115].…”

Section: Functional Outcomesmentioning

confidence: 99%

Local Excision for the Management of Early Rectal Cancer

Quaresima¹,

Palmieri²,

Balla³

et al. 2024

Current Concepts and Controversies in Laparoscopic Surgery

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Transanal endoscopic microsurgery (TEM) is a minimally invasive technique introduced in the 1980s to overcome the technical difficulties in the management of low rectal tumors. The TEM system includes a dedicated rigid rectoscope and platform with a dedicated expensive instrumentation. The transanal minimally invasive surgery (TAMIS) technique was introduced to overcome these limitations. Transanal surgery consists of three main steps: exposure of the lesion, tumor excision, and defect closure. Traditional indications are benign adenomas and selected T1 rectal cancers. However, when combined with neoadjuvant chemoradiotherapy (n-CRT), the indications may be extended to patients with selected T2-T3 rectal cancers responsive to n-CRT. Intraoperative complications may be difficult to deal with, but peritoneal entry is adequately managed by endoluminal direct closure of the defect by expert surgeons. Concerning the indications for defect closure, there is no evidence of better results to prevent complications such as bleeding; the indication for defect closure should be evaluated according to multiple variables. The management of other complications is safe and does not affect TEM’s oncological and functional outcomes. Transanal excision of rectal tumor is a safe and effective alternative to conventional resection to avoid the low anterior resection syndrome, with comparable oncological results and with the advantages of an organ-sparing strategy for better patients’ QoL.

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Preoperative chemoradiotherapy affects postoperative outcomes and functional results in patients treated with transanal endoscopic microsurgery for rectal neoplasms

Cited by 14 publications

References 58 publications

Role of Local Excision for Suspected Regrowth in a Watch and Wait Strategy for Rectal Cancer

Role of Local Excision for Suspected Regrowth in a Watch and Wait Strategy for Rectal Cancer

Transanal Endoscopic Microsurgery Versus Total Mesorectal Excision in ypT0-1 Rectal Cancer After Preoperative Radiochemotherapy: Postoperative Morbidity, Functional Results, and Long-term Oncologic Outcome

Local Excision for the Management of Early Rectal Cancer

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