Further evidence for preoperative chemoradiotherapy and transanal endoscopic surgery (TEM) in T2-3s,N0,M0 rectal cancer.

Abstract

Preoperative chemoradiotherapy and local excision via transanal endoscopic surgery (TEM) in T2-3s,N0,M0 rectal cancer achieve promising results in selected patients. We describe our long-term follow-up experience with this combination, and evaluate complete clinical and pathological responses, local recurrence and overall survival. The prospective observational follow-up study carried out since 2007. Out of 476 consecutive patients treated with TEM, we selected those with adenocarcinoma of low or moderate grade of differentiation, clinical stages T2-superficial T3,N0,M0, who refused radical surgery. Preoperative chemoradiotherapy comprised 5-fluorouracil or capecitabine combined with radiotherapy at a dose of 50.4Gy. TEM was performed after 8 weeks. Complications were recorded and long-term follow-up was conducted. Fifteen patients undergoing preoperative chemoradiotherapy and TEM (median age 76years, 95% CI 70.3-80.4, and median follow-up 38months, 95% CI 20-44) were studied. No local recurrence was observed, and only one patient (6.7%) presented systemic relapse. The overall survival was 76%. Complete clinical response was achieved in seven patients (46.7%) and complete pathological response in four (26.7%). With regard to toxicity associated with neoadjuvant treatment, four patients (26.7%) developed grade 3 adverse effects; no grade 4 or 5 adverse effects were observed. There was no postoperative mortality. The results of our study, with a response rate of 26.7% and without local relapse, support the treatment of T2-3s,N0,M0 of rectal cancer with preoperative chemoradiotherapy and local excision (TEM).