Top

Published in:

01-08-2013

Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome

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

Published in: Surgical Endoscopy | Issue 8/2013

Abstract

Background

Transanal endoscopic microsurgery (TEM) after radiochemotherapy (RCT) has been reported in selected cases of locally advanced rectal cancer as an alternative to traditional radical resection with total mesorectal excision with a curative intent or as diagnostic tool to confirm a pathological complete response of the primary tumor. No study has evaluated functional outcome after TEM in preoperatively irradiated patients.

Methods

This study was designed to evaluate short-term morbidity (according to Clavien’s classifications) and establish (by a questionnaire) continence and evacuative function after RCT and TEM, at 1 year from surgery, analyzing the impact of RCT on postoperative outcomes. Patients with locally advanced rectal cancer treated by RCT and TEM (group 1) or with early T1 or adenomas treated only by TEM (group 2) entered this cohort comparative study.

Results

Twenty-two patients entered the study as group 1 and 25 as group 2. No postoperative mortality occurred. The morbidity rate was 36.4 % in group 1 vs. 16 % in group 2 (p = 0.114). The rate of suture dehiscence was 22.7 % in group 1 vs. 4 % in group 2 (p = 0.068). No grade III complications, reoperation, or hospital readmission within 30 days was recorded in either group. One year after surgery, continence and evacuative scores in group 1 were 1.05 ± 1.25 and 24.72 ± 2.79, respectively, which were similar to group 2 (p = 0.081 and 0.288, respectively).

Conclusions

TEM after RCT in selected rectal cancer patients has an acceptable morbidity and functional results at 1 year from surgery. Preoperative irradiation could increase postoperative short-term morbidity, but it does not seem to influence evacuative or sphincter function after 1 year from surgery.

Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Eng J Med 351:1731–1740CrossRef

Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646PubMedCrossRef

Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 69:613–616PubMedCrossRef

Kapiteijn E, Putter H, van de Velde CJ, Cooperative investigators of the Dutch ColoRectal Cancer Group (2002) Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands. Br J Surg. 89:1142–1149

Ridgway PF, Darzi AW (2003) The role of total mesorectal excision in the management of rectal cancer. Cancer Control 10:205–211PubMed

Pinsk I, Phang PT (2007) Total mesorectal excision and management of rectal cancer. Expert Rev Anticancer Ther 7:1395–1403PubMedCrossRef

Coco C, Valentini V, Manno A, Rizzo G, Gambacorta MA, Mattana C et al (2007) Functional results after radiochemotherapy and total mesorectal excision for rectal cancer. Int J Colorectal Dis 22:903–910PubMedCrossRef

Dahlberg M, Glimelius B, Graf W, Påhlman L (1998) Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum 41:543–549PubMedCrossRef

Bujko K, Nowacki MP, Oledzki J, Sopyło R, Skoczylas J, Chwaliński M (2001) Sphincter preservation after short-term preoperative radiotherapy for low rectal cancer–presentation of own data and a literature review. Acta Oncol 40:593–601PubMedCrossRef

10.

Pucciarelli S, Urso E, DeSalvo GL, Aschele C, Friso ML, Rugge M et al (2006) 5-fluorouracil and weekly oxaliplatin combined with radiotherapy for locally advanced rectal cancer: surgical complications and long-term results. Arch Med Res 37:860–865PubMedCrossRef

11.

Capirci C, Valentini V, Cionini L, De Paoli A, Rodel C, Glynne-Jones R et al (2008) Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 72:99–107PubMedCrossRef

12.

Yeo SG, Kim DY, Kim TH, Chang HJ, Oh JH, Park W et al (2010) Pathologic complete response of primary tumor following preoperative chemoradiotherapy for locally advanced rectal cancer: long-term outcomes and prognostic significance of pathologic nodal status (KROG 09–01). Ann Surg 252:998–1004PubMedCrossRef

13.

Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo LJ et al (2010) Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 11:835–844PubMedCrossRef

14.

Lezoche G, Baldarelli M, Guerrieri M, Paganini AM, De Sanctis A, Bartolacci S et al (2008) A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 22:352–358PubMedCrossRef

15.

Callender GG, Das P, Rodriguez-Bigas MA, Skibber JM, Crane CH, Krishnan S (2010) Local excision after preoperative chemoradiation results in an equivalent outcome to total mesorectal excision in selected patients with T3 rectal cancer. Ann Surg Oncol 17:441–447PubMedCrossRef

16.

Coco C, Manno A, Mattana C, Verbo A, Rizzo G, Valentini V et al (2007) The role of local excision in rectal cancer after complete response to neoadjuvant treatment. Surg Oncol 16(Suppl 1):S101–S104PubMedCrossRef

17.

Cataldo PA, O’Brien S, Osler T (2005) Transanal endoscopic microsurgery: a prospective evaluation of functional results. Dis Colon Rectum 48:1366–1371PubMedCrossRef

18.

Doornebosch PG, Tollenaar RA, Gosselink MP, Stassen LP, Dijkhuis CM, Schouten WR et al (2007) Quality of life after transanal endoscopic microsurgery and total mesorectal excision in early rectal cancer. Colorectal Dis 9:553–558PubMedCrossRef

19.

Allaix ME, Rebecchi F, Giaccone C, Mistrangelo M, Morino M (2011) Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 98:1635–1643PubMedCrossRef

20.

Marks JH, Valsdottir EB, DeNittis A, Yarandi SS, Newman DA, Nweze I et al (2009) Transanal endoscopic microsurgery for the treatment of rectal cancer: comparison of wound complication rates with and without neoadjuvant radiation therapy. Surg Endosc 23:1081–1087PubMedCrossRef

21.

Perez RO, Habr-Gama A, São Julião GP, Proscurshim I, Scanavini Neto A, Gama-Rodrigues J (2011) Transanal endoscopic microsurgery for residual rectal cancer after neoadjuvant chemoradiation therapy is associated with significant immediate pain and hospital readmission rates. Dis Colon Rectum 54:545–551PubMedCrossRef

22.

Coco C, Valentini V, Manno A, Mattana C, Verbo A, Cellini N et al (2006) Long-term results after neoadjuvant radiochemotherapy for locally advanced resectable extraperitoneal rectal cancer. Dis Colon Rectum 49:311–318PubMedCrossRef

23.

Gambacorta MA, Valentini V, Coco C, Morganti AG, Smaniotto D, Miccichè F et al (2004) Chemoradiation with raltitrexed and oxaliplatin in preoperative treatment of stage II-III resectable rectal cancer: phase I and II studies. Int J Radiat Oncol Biol Phys 60:139–148PubMedCrossRef

24.

Hospers GA, Punt CJ, Tesselaar ME, Cats A, Havenga K, Leer JW et al (2004) Preoperative chemoradiotherapy with capecitabine and oxaliplatin in locally advanced rectal cancer. A phase I–II multicenter study of the Dutch Colorectal Cancer Group. Ann Surg Oncol 14:2773–2779CrossRef

25.

Glynne-Jones R, Sebag-Montefiore D, Maughan TS, Falk SJ, McDonald AC (2006) A phase I dose escalation study of continuous oral capecitabine in combination with oxaliplatin and pelvic radiation (XELOX-RT) in patients with locally advanced rectal cancer. Ann Surg Oncol 17:50–56

26.

Miller AB (1981) Reporting result of cancer treatment. Cancer 47:207–214PubMedCrossRef

27.

Valentini V, Coco C, Cellini N, Picciocchi A, Fares MC, Rosetto ME et al (2001) Ten years of preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, sphincter preservation in three consecutive studies. Int J Radiat Oncol Biol Phys 51:371–383PubMedCrossRef

28.

Buess G, Hutterer F, Theiss J, Bobel M, Isselhard W, Pichlmaier H (1984) A system for a transanal endoscopic rectum operation. Chirurg 55:677–680PubMed

29.

Sobin LH (2001) TNM classification of malignant tumors, 6th edn. Wiley, Hoboken

30.

Mandard AM, Dalibard F, Mandard JC, Marnay J, Henry-Amar M, Petiot JF et al (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma: clinicopathologic correlations. Cancer 73:2680–2686PubMedCrossRef

31.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef

32.

Gervaz P, Rotholtz N, Wexner SD, You SY, Saigusa N, Kaplan E et al (2001) Colonic J-pouch function in rectal cancer patients. Impact of adjuvant chemoradiotherapy. Dis Colon Rectum 14:1667–1675CrossRef

33.

Jorge JMN, Wexner SD (1993) Etiology and management of faecal incontinence. Dis Colon Rectum 36:77–97PubMedCrossRef

34.

Read TE, Andujar JE, Caushaj PF, Johnston DR, Dietz DW, Myerson RJ (2004) Neoadjuvant therapy for rectal cancer: histologic response of the primary tumor predicts nodal status. Dis Colon Rectum 47:825–831PubMedCrossRef

35.

Guerrieri M, Baldarelli M, Morino M, Trompetto M, Da Rold A, Selmi I et al (2006) Transanal endoscopic microsurgery in rectal adenomas: experience of six Italian centers. Dig Liver Dis 38:202–207PubMedCrossRef

36.

Bretagnol F, Merrie A, George B, Warren BF, Mortensen NJ (2007) Local excision of rectal tumors by transanal endoscopic microsurgery. Br J Surg 94:627–633PubMedCrossRef

37.

Suppiah A, Maslekar S, Alabi A, Hartley JE, Monson JR (2008) Transanal endoscopic microsurgery in early rectal cancer: time for a trial? Colorectal Dis 10:314–327PubMedCrossRef

38.

Caricato M, Borzomati D, Ausania F, Tonini G, Rabitti C, Valeri S et al (2006) Complementary use of local excision and transanal endoscopic microsurgery for rectal cancer after neoadjuvant chemoradiation. Surg Endosc 20:1203–1207PubMedCrossRef

39.

Stone HB, Coleman N, Anscher MS, McBride WH (2003) Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol 4:529–536PubMedCrossRef

40.

Kennedy ML, Lubowski DZ, King DW (2002) Transanal endoscopic microsurgery excision: is anorectal function compromised? Dis Colon Rectum 45:601–604PubMedCrossRef

41.

Herman RM, Richter P, Walega P, Popiela T (2001) Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery. Int J Colorectal Dis 16:370–376PubMedCrossRef

Title: Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome
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
Publication date: 01-08-2013
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-2842-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2013

ERCP via gastrostomy vs. double balloon enteroscopy in patients with prior bariatric Roux-en-Y gastric bypass surgery

“Triangle of safety”: anatomic considerations in transvaginal natural orifice surgery

Innovative noninsufflation EFTR: sufficient endoscopic operative field by mechanical counter traction device

Combined endoscopic techniques for closure of a chronic post-surgical gastrocutaneous fistula: case report and review of the literature (with video)

Miniprobe endoscopic ultrasound accurately stages esophageal cancer and guides therapeutic decisions in the era of neoadjuvant therapy: results of a multicenter cohort analysis

Teaching and training in laparoscopic inguinal hernia repair (TAPP): impact of the learning curve on patient outcome