Transanal endoscopic operation for rectal cancer after neoadjuvant therapy

Abstract

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.

Evaluation of the Response Rate to Neoadjuvant Chemoradiotherapy in Patients with Rectal Adenocarcinoma: A Retrospective Long-term Study in Two Terciary Reference Centers

“…Less invasive therapeutic alternative than transabdominal surgeries, as effective as conventional transanal excisions, with a lower risk of complications, with low-cost and easy-to-use surgical equipment. 17,18 Of these 50 patients who underwent local resection, 46 (92%) underwent conformational 3D/IMRT radiotherapy, suggesting that the use of modern radiotherapy techniques may reflect better local control, enabling less invasive resections after neoadjuvant therapy.…”

Surgical and Postoperative Evaluations of Rectal Adenomas Ecised With a Novel Proctoscope.

“…The initial cost of specialized TEM equipment is perceived by some surgeons as a limiting factor for the widespread adoption of this technique (23). The proctoscope used in this study is cheap (approximately U$ 300), and conventional and laparoscopic surgical instruments can be used without the need for gas insu ation, providing a three-dimensional view and allowing greater accessibility for surgeons (10,11,24).…”

Surgical and postoperative evaluations of rectal adenomas excised with a rigid proctoscope

“…The initial cost of specialized TEM equipment is perceived by some surgeons as a limiting factor for the widespread adoption of this technique 23 . The proctoscope used in this study is cheap (approximately U$ 300), and conventional and laparoscopic surgical instruments can be used without the need for gas insufflation, providing a three-dimensional view and allowing greater accessibility for surgeons 10 , 11 , 24 .…”