ABSTRACT
BACKGROUND: Local therapy for early rectal cancer is a valid alternative to the classical radical operation, which has a higher morbidity and mortality rate. The use of high-dose preoperative radiation appears to enhance the options for sphincter-saving surgery even for T2-T3 rectal cancer patients with effective local control. The authors report their experience with transanal endoscopic microsurgery (TEM) used to manage selected cases of distal rectal cancer without evidence of nodal or distant metastasis (N0-M0). METHODS: The study enrolled 196 patients with rectal cancer (51 T1, 84 T2, and 61 T3). All the patients staged preoperatively as T2 and T3 underwent preoperative high-dose radiotherapy, and since 1997, patients younger than 70 years in good general condition also have undergone preoperative chemotherapy. RESULTS: Minor complications were observed in 17 patients (8.6%) and major complications in only 3 patients (1.5%). The definitive histology was 33 pT0 (17%), 73 pT1 (37%), 66 pT2 (34%), and 24 pT3 (12%). Eight patients (5 pT2 and 3 pT3) experienced local recurrence (4.1%). The rectal cancer-specific survival rate at the end of the follow-up period was 100% for pT1, 90% for pT2, and 77% for pT3 patients. CONCLUSIONS: Patients with T1 cancer and favorable histologic features may undergo local excision alone, whereas those with T2 and T3 rectal cancer require preoperative radiochemotherapy. The results in the authors' experience after TEM appear not to be substantially different in terms of local recurrence and survival rate from those described for conventional surgery.
Subject(s)
Adenocarcinoma/surgery , Microsurgery/methods , Rectal Neoplasms/surgery , Adenocarcinoma/drug therapy , Adenocarcinoma/radiotherapy , Aged , Antimetabolites, Antineoplastic/administration & dosage , Antimetabolites, Antineoplastic/therapeutic use , Combined Modality Therapy , Disease-Free Survival , Female , Fluorouracil/administration & dosage , Fluorouracil/therapeutic use , Humans , Male , Middle Aged , Neoadjuvant Therapy , Neoplasm Recurrence, Local , Neoplasm Staging , Patient Selection , Postoperative Complications , Rectal Neoplasms/drug therapy , Rectal Neoplasms/radiotherapy , Retrospective StudiesABSTRACT
Transanal endoscopic microsurgery (TEM), associated with preoperative radiotherapy in selected groups, allows minimally invasive full thickness local excision of rectal tumors with perirectal fat dissection. In our experience, 95 patients with extraperitoneal rectal carcinoma underwent TEM resection for T1 (21 cases), T2 (48 cases) and T3 (15 cases) lesions. In eleven patients the pathologist did not find cancer cells in the specimen (pT0) after full dose of radiotherapy and TEM. The postoperative results were as follows: 11 minor complications (11.6%), 7 leaking sutures, 3 stool incontinence and 1 rectal haemorrhage, that resolved with medical therapy and two major complications (2.1%), one rectovaginal fistula that required reoperation and one rectourethral fistula treated by conservative therapy. No perioperative mortality was observed. Mean follow up was 40 months (range 2-96 months) with 7 (7.4%) local recurrences. Of those, 5 patients were successfully retreated and 2 high risk patients underwent postoperative radiotherapy. The overall survival in T0 and T1 patients was 100%. The overall survival in T2 and T3 patients was 81% and 62.1% respectively. This study reports the application of TEM combined with radiotherapy in the treatment of rectal cancer in selected patients. This approach is feasible, safe, and appears to be effective at the present follow up, with preservation of normal sphincter function.
