Transanal endoscopic versus total mesorectal laparoscopic resections of T2–N0 low rectal cancers after neoadjuvant treatment: a prospective randomized trial with a 3-years minimum follow-up period

Abstract

The findings show comparative results between the two study arms in terms of probability of failure and survival.

Is the increasing role of Transanal Endoscopic Microsurgery in curation for T1 rectal cancer justified? A systematic review

“…The only series on TEM following neoadjuvant chemoradiotherapy showed the procedure to be feasible with promising early results [66]. Again however, before definite conclusions can be drawn, larger, randomized studies have to be initiated.…”

“…If local control is improved by preoperative radiotherapy and preoperative chemoradiotherapy results in sterilizing lymph node metastases, local excision following preoperative chemoradiotherapy might be a logical step. One randomized controlled trial investigating this treatment strategy was performed [66]. Forty patients with histological proven adenocarcinomas, staged as uT2-N0-M0, G1/2, within 6 cm from the anal verge, were randomized to TEM or laparoscopic TME.…”

Transanal Endoscopic Microsurgery

“…Local excision of advanced rectal cancers with curative intent remains a debatable issue. The review recommended that TEM only be used for palliative cases in T2-T3 tumors, nevertheless, researchers in several studies have described that TEM is safe and effective for patients with rectal carcinoma pT2 N0 low risk after neoadjuvant therapy and pT3 N0 low risk and complete response after neoadjuvant therapy who refused abdominal surgery [4,5,[9][10][11][12][13]22,26,[30][31][32]. Our experience has shown that neoadjuvant therapy followed by TEM to treat T2-3 N0 rectal cancer is well tolerated and effective.…”

“…TEM of more advanced rectal cancer remains a controversial issue. However TEM has recently become a more attractive option because of the regular use of neoadjuvant therapy at several centers [4,5,[8][9][10][11][12][13]. Still other indications have also been described: repair of high or supralevator fistulas, rectourethral fistulas and rectal prolapse, drainage of pelvic collections, impacted fecaloma and excision of extra rectal masses [5,[14][15][16].…”

Transanal Excision with Radiation Therapy for Rectal Adenocarcinoma

“…[2][3][4][5] Postoperative chemoradiotherapy is a reasonable option for patients who were thought to have T1 lesions, but then on pathology, had either a higher stage lesion or unfavorable histology. 6 NCCN guidelines currently recommend abdominal surgery for these patients, but patients might decline this option for a number of reasons.…”