Neoadjuvant therapy and transanal endoscopic surgery in T2-T3 superficial, N0, M0 rectal tumors. Local recurrence, complete clinical and pathological response

Xavier Serra-Aracil, Carlos Pericay, Laura Mora-Lopez, Juan Carlos Garcia Pacheco, José Isaac Latorraca, Julio Ocaña-Rojas, Alex Casalots, Eva Ballesteros, Salvador Navarro-Soto

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3 Citations (Scopus)

Abstract

© 2017 AEC Introduction The association of preoperative chemoradiotherapy and transanal endoscopic surgery in T2 and superficial T3 rectal cancers presents promising results in selected patients. The main objective is to evaluate the long-term loco-regional and systemic recurrence and, as secondary objectives, to provide results of postoperative morbidity and the correlation between complete clinical and pathological response. Methods This is a retrospective observational study including a consecutive series of patients with T2-T3 superficial rectal cancer, N0, M0 who refused radical surgery (2008-2016). The treatment consisted of preoperative chemotherapy (5-fluorouracil or capecitabine) combined with radiotherapy (50, 4 Gy) and transanal endoscopic surgery after 8 weeks. Preoperative, surgical, pathological and long-term oncologic results were analyzed. Results Twenty-four patients were included in the study. Two of them required rescue radical surgery for unfavorable pathological results. A local recurrence (4.5%) was observed and 2 patients presented systemic recurrence (9%), with a median follow-up of 45 months. A complete clinical tumor response was achieved in 12 patients (50%), and complete pathological tumor response in 9 patients (37.5%). Postoperative complications were observed in 5 patients (20.8%), and they were mild except one. There was no postoperative mortality. Conclusions In this stage of rectal cancer, our results seem to support this strategy, mainly when a complete pathological response is achieved. The complete clinical tumor response does not coincide with the pathological tumor response. Randomized prospective studies should be performed to standardize this treatment.
Original languageEnglish
Pages (from-to)199-207
JournalCirugia Espanola
Volume95
Issue number4
DOIs
Publication statusPublished - 1 Apr 2017

Keywords

  • Neoadjuvant therapy and rectal cancer
  • Preoperative chemoradiotherapy and rectal cancer
  • Rectal cancer
  • Rectal cancer T2
  • Rectal cancer T3 superficial

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