BACKGROUND: Neoadjuvant therapies have significantly improved local control and survival of patients with rectal cancer. Nevertheless, although a complete pathologic response can be achieved in 30% of cases, a transabdominal surgical resection is always required. This study aimed, for the first time, to test in the literature the feasibility of local excision combined with transanal endoscopic microsurgery (TEM) as a surgical option for patients treated with neoadjuvant chemoradiation. METHODS: Between July 1997 and December 2002, 30 patients with rectal cancer affected by an extraperitoneal tumor entered a protocol consisting of neoadjuvant chemoradiation followed by surgery. The surgical treatment, consisting of open surgery, local excision, or TEM, was planned according to the patient's clinical response after chemoradiation and distance from the anal verge. RESULTS: A significant clinical downstaging was observed in eight patients. Five of these patients underwent TEM, and three had local excision. Consequently, open surgery was performed for 22 patients. Histology showed six cases of complete pathologic response: three in the open surgery group and three in the transanal excision group. After a mean follow-up period of 47 months, the disease-free survival rate was 77% in the open surgery group and 100% in TEM or local excision group. CONCLUSIONS: The findings suggest the complementary feasibility of TEM and local excision after neoadjuvant chemoradiation. However, randomized trials are needed to confirm the oncologic safety of this approach.
BACKGROUND: Neoadjuvant therapies have significantly improved local control and survival of patients with rectal cancer. Nevertheless, although a complete pathologic response can be achieved in 30% of cases, a transabdominal surgical resection is always required. This study aimed, for the first time, to test in the literature the feasibility of local excision combined with transanal endoscopic microsurgery (TEM) as a surgical option for patients treated with neoadjuvant chemoradiation. METHODS: Between July 1997 and December 2002, 30 patients with rectal cancer affected by an extraperitoneal tumor entered a protocol consisting of neoadjuvant chemoradiation followed by surgery. The surgical treatment, consisting of open surgery, local excision, or TEM, was planned according to the patient's clinical response after chemoradiation and distance from the anal verge. RESULTS: A significant clinical downstaging was observed in eight patients. Five of these patients underwent TEM, and three had local excision. Consequently, open surgery was performed for 22 patients. Histology showed six cases of complete pathologic response: three in the open surgery group and three in the transanal excision group. After a mean follow-up period of 47 months, the disease-free survival rate was 77% in the open surgery group and 100% in TEM or local excision group. CONCLUSIONS: The findings suggest the complementary feasibility of TEM and local excision after neoadjuvant chemoradiation. However, randomized trials are needed to confirm the oncologic safety of this approach.
Authors: E Kapiteijn; C A Marijnen; I D Nagtegaal; H Putter; W H Steup; T Wiggers; H J Rutten; L Pahlman; B Glimelius; J H van Krieken; J W Leer; C J van de Velde Journal: N Engl J Med Date: 2001-08-30 Impact factor: 91.245
Authors: Nestor F Esnaola; Scott B Cantor; Margo L Johnson; Attiqa N Mirza; Alexander R Miller; Steven A Curley; Christopher H Crane; Charles S Cleeland; Nora A Janjan; John M Skibber Journal: J Clin Oncol Date: 2002-11-01 Impact factor: 44.544
Authors: E Lezoche; M Guerrieri; A M Paganini; G D'Ambrosio; M Baldarelli; G Lezoche; F Feliciotti; A De Sanctis Journal: Surg Endosc Date: 2005-05-04 Impact factor: 4.584
Authors: C J Kim; T J Yeatman; D Coppola; A Trotti; B Williams; J S Barthel; W Dinwoodie; R C Karl; J Marcet Journal: Ann Surg Date: 2001-09 Impact factor: 12.969
Authors: Scott R Schell; Robert A Zlotecki; William M Mendenhall; Robert W Marsh; J Nicolas Vauthey; Edward M Copeland Journal: J Am Coll Surg Date: 2002-05 Impact factor: 6.113
Authors: Leyo Ruo; Satish Tickoo; David S Klimstra; Bruce D Minsky; Leonard Saltz; Madhu Mazumdar; Philip B Paty; W Douglas Wong; Steven M Larson; Alfred M Cohen; Jose G Guillem Journal: Ann Surg Date: 2002-07 Impact factor: 12.969
Authors: Felipe A Calvo; Marta Domper; Raúl Matute; Raúl Martínez-Lázaro; José A Arranz; Manuel Desco; Emilio Alvarez; José Luis Carreras Journal: Int J Radiat Oncol Biol Phys Date: 2004-02-01 Impact factor: 7.038
Authors: John H Marks; E B Valsdottir; A DeNittis; S S Yarandi; D A Newman; I Nweze; M Mohiuddin; G J Marks Journal: Surg Endosc Date: 2009-03-05 Impact factor: 4.584
Authors: C Coco; G Rizzo; C Mattana; M A Gambacorta; A Verbo; B Barbaro; F M Vecchio; D P Pafundi; M G Mastromarino; V Valentini Journal: Surg Endosc Date: 2013-02-13 Impact factor: 4.584