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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2016

01-04-2016 | Colorectal Cancer

Transanal Endoscopic Microsurgery (TEM) Following Neoadjuvant Chemoradiation for Rectal Cancer: Outcomes of Salvage Resection for Local Recurrence

Authors: Rodrigo Oliva Perez, MD, PhD, Angelita Habr-Gama, MD, PhD, Guilherme Pagin São Julião, MD, Igor Proscurshim, MD, Laura Melina Fernandez, MD, Rafael Ulysses de Azevedo, MS, Bruna B. Vailati, MD, Felipe Alexandre Fernandes, MS, Joaquim Gama-Rodrigues, MD, PhD

Published in: Annals of Surgical Oncology | Issue 4/2016

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Abstract

Background

Transanal endoscopic microsurgery (TEM) has been considered an alternative for selected patients with rectal cancer following neoadjuvant chemoradiation (CRT). Immediate total mesorectal completion for all patients with unfavorable pathological features would result in unnecessary protectomies in a significant proportion of patients. Instead, salvage total mesorectal excision (TME) could be restricted for patients developing local recurrence. The aim of the present study is to determine oncological outcomes of salvage resection for local recurrences following CRT and TEM.

Methods

Consecutive patients undergoing TEM following neoadjuvant CRT for rectal cancer were reviewed. Patients with “near” complete response to CRT (≤3 cm; ycT1-2N0) were offered TEM. Salvage surgery was attempted in the event of a local recurrence.

Results

A total of 53 patients were managed by CRT followed by TEM. Unfavorable pathological features were present in 36 patients (68 %). None of the patients underwent immediate completion TME. There were 12 patients who developed local recurrence resulting in a 2-year local recurrence-free survival of 77 % (95 % CI, 53–100 %). Of these patients, 9 developed exclusively local recurrences, and all had at least 1 unfavorable pathological feature in the specimen after TEM (100 %). Eight patients (8 of 9) underwent salvage resection (abdominoperineal resection [APR] in 87 %) with CRM+ in 7 of 8 patients (87 %). Four patients developed local re-recurrence after a median 36 months of follow-up. The 2-year local re-recurrence free survival was 60 %.

Conclusions

Salvage resection for local recurrence following CRT and TEM is associated with high rates of R1 resection (CRM+) and local re-recurrence. Immediate completion of TME should be considered for patients with unfavorable pathological features after TEM.
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Metadata
Title
Transanal Endoscopic Microsurgery (TEM) Following Neoadjuvant Chemoradiation for Rectal Cancer: Outcomes of Salvage Resection for Local Recurrence
Authors
Rodrigo Oliva Perez, MD, PhD
Angelita Habr-Gama, MD, PhD
Guilherme Pagin São Julião, MD
Igor Proscurshim, MD
Laura Melina Fernandez, MD
Rafael Ulysses de Azevedo, MS
Bruna B. Vailati, MD
Felipe Alexandre Fernandes, MS
Joaquim Gama-Rodrigues, MD, PhD
Publication date
01-04-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4977-2

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