Transanal Endoscopic Microsurgery for Residual Rectal Cancer (ypT0-2) Following Neoadjuvant Chemoradiation Therapy

Perez, Rodrigo Oliva; Habr‐Gama, Angelita; Lynn, Patricio B.; Julião, Guilherme Pagin São; Bianchi, Romina; Proscurshim, Igor; Gama-Rodrigues, Joaquim

doi:10.1097/dcr.0b013e318273f56f

Cited by 117 publications

(87 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The high number of ypT2 and ypT3 operated tumors could explain the 10.3% recurrence rate observed in the present study. Higher recurrence rates in stage II and III patients have previously been observed 27,28 . Both surgeon and patients should be aware this risk when contemplating any local excision procedure.…”

Section: Resultsmentioning

confidence: 85%

Transanal endoscopic operation for rectal cancer after neoadjuvant therapy

et al. 2016

View full text Add to dashboard Cite

PURPOSE:In this paper we report the oncological outcomes from clinical series of patients with rectal cancer submitted to local excision after neoadjuvant therapy and discuss the indications for local excision in partial clinical responders. METHODS:We analysed a prospective database of 39 patients submitted to a transanal endoscopic operation for rectal cancer after neoadjuvant chemoradiation between 2006 and 2015, comparing clinical and pathological variables, perioperative complications, recurrence rate and overall survival. RESULTS:We obtained 15.4% ypT0, 17.9% ypT1, 35.9% ypT2 and 28.2% ypT3. After a median follow-up of 24 months, tumoral recurrence was observed in 4 patients, one of them with isolated pulmonary metastasis. R0 resection was achieved in 79.5%, and postoperative complications were observed in 30.2% patients and no perioperative mortality occur. Compromise surgical margins do not affect recurrence rate, and 94.9% of patients are alive nowadays. CONCLUSION:Local excision could be associated with low recurrence rate and good overall survival. Short hospitalization time and low level of serious complications observed could be an interesting option for patients who would not tolerate a radical procedure or for those who declined a total mesorectal excision. A strict long-term follow-up must be warranted to detect early tumoral recurrence.

show abstract

Section: Resultsmentioning

confidence: 85%

Transanal endoscopic operation for rectal cancer after neoadjuvant therapy

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The authors addressed that when complete pathological response was achieved (ypT0), local recurrence was 0% and systemic recurrence was 4%, in ypT1 tumors, local recurrence was 2% and systemic recurrence was 7%, in ypT2 tumors, both local and systemic recurrence rose to 7%, while when there was no response (ypT3), the local recurrence was 21% and the systemic recurrence was 12% after local excision. Similarly, a prospective study [94] of 27 patients with ypT0-2 tumors in the lower rectum after neoadjuvant CRT, treated by TEM, showed a local recurrence rate of 15% within a median follow-up of 15 mo. Lymphovascular invasion was disclosed as the only independent dismal prognostic factor for local failure (P = 0.04), while tumor size, ypT status, T-status downstaging, lateral/radial margins and tumor regression grade, did not reach statistical significance.…”

Section: Long-term Results Studies On the Oncological Outcome Followimentioning

confidence: 99%

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Dimitriou

Michail

Moris

et al. 2015

WJGO

View full text Add to dashboard Cite

Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal PlanE for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic MicroSurgery (TEM) and TransAnal Minimally Invasive Surgery (TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery. Core tip: The present review presents the most recent advances in the field of sphincter preserving surgery for the treatment of low rectal cancer patients, providing indications, patients' selection, surgical techniques, multimodality approaches, postoperative course and oncological and functional outcomes. In particular, the review focuses on data deriving from prospective EDITORIAL

show abstract

“…27 These results are quite improved over the prior studies which showed up to a 15% recurrence rate. 28 Certainly, there will need to be improvements in our ability to characterize tumor response to neoadjuvant therapy radiologically before local excision can be routinely recommended.…”

Section: Local Therapymentioning

confidence: 99%

Current Concepts in Rectal Cancer

Fleshman

Smallwood

2015

Clinics in Colon and Rectal Surgery

View full text Add to dashboard Cite

Since the first recorded surgical resection for rectal cancer in 1826 by Jacques Lisfranc, 1 the management of rectal cancer has evolved remarkably with dramatic improvements in local recurrence and mortality. Surgical resection is the only proven curative treatment of rectal cancer and the important advances in care have involved improvements in surgical techniques. Most of these improvements during this time period resulted from a better understanding of the anatomy and pathology of rectal cancer. It is important to be familiar with these important advances in rectal cancer treatment to fully understand the current methods of treatment.Historical Overview: From Miles' Abdominoperineal Resection to Today's Sphincter-Preserving Techniques Rectal Resections before MilesGiovanni Morgagni in the early 18th century was the first to propose rectal resection as a treatment for cancer. 1 However, it took over a century before the first successful rectal resection was performed. Over the years, there have been constant changes in the approach used by surgeons to perform a rectal resection.Rectal resections were first performed using a perineal approach as described in 1826 by Jacques LisFranc. 1,2 He operated in the era before anesthesia and proper antiseptic techniques. Since inadvertent entry into the peritoneal cavity could prove lethal, he chose the perineal approach to evert the rectum and perform a limited resection below the peritoneal reflection. A limited amount of rectum was resected with this approach and no attempt was made to purposely include the mesorectum and draining lymph nodes. 2 Success at that time was based upon whether the patient survived to leave the hospital, and so the risk of local recurrence had very little influence. With the advent of anesthesia and aseptic techniques, operations could now be performed that would provide for a more radical resection. Paul Kraske developed a technique similar to Kocher's technique, where he would incise and detach the left side of the coccyx and sacrum to provide more exposure. This exposure allowed him to resect the rectal cancer with ½ inch margins on either side of the rectum. The proximal bowel would then be pulled down and sutured to the anal sphincter complex. However, this "sacral anus" was difficult for the patient to manage. 1,3 Carl Guessenbauer performed the first transabdominal rectal resection and with closure and colostomy in 1879. This procedure would be later popularized by Henri Hartmann for the purpose of treating diverticulitis. 4 Vincent Czerny is credited with performing the first combined abdominal and perineal approach. This combined approach was never intended but was performed only after an unsuccessful attempt at resection through the perineal approach. 1 In Vogel's review of 1,500 cases performed by 12 of the most prominent 19th century surgeons including Billroth, Kocher, Kraske, and Czerny there was a 21% operative mortality rate with a high (80%) recurrence rate. 3 Surgery certainly had progressed beyond LisFranc's perineal res...

show abstract

Transanal Endoscopic Microsurgery for Residual Rectal Cancer (ypT0-2) Following Neoadjuvant Chemoradiation Therapy

Abstract: A local failure rate of 15% after transanal endoscopic microsurgery for patients with residual rectal cancers restricted to the bowel wall (ypT0-2) may limit the indication of this procedure to highly selected patients as an alternative to standard radical total mesorectal excision.

Cited by 117 publications

References 22 publications

Transanal endoscopic operation for rectal cancer after neoadjuvant therapy

Transanal endoscopic operation for rectal cancer after neoadjuvant therapy

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Current Concepts in Rectal Cancer

Contact Info

Product

Resources

About