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

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Angelita and Joaquim Gama Institute, São Paulo, Brazil

    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

  2. Colorectal Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil

    Rodrigo Oliva Perez MD, PhD

  3. São Paulo Branch, Ludwig Institute for Cancer Research, São Paulo, Brazil

    Rodrigo Oliva Perez MD, PhD

  4. University of São Paulo School of Medicine, São Paulo, Brazil

    Angelita Habr-Gama MD, PhD, Rafael Ulysses de Azevedo MS, Felipe Alexandre Fernandes MS & Joaquim Gama-Rodrigues MD, PhD

Authors
  1. Rodrigo Oliva Perez MD, PhD
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  2. Angelita Habr-Gama MD, PhD
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  3. Guilherme Pagin São Julião MD
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  4. Igor Proscurshim MD
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  5. Laura Melina Fernandez MD
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  6. Rafael Ulysses de Azevedo MS
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  7. Bruna B. Vailati MD
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  8. Felipe Alexandre Fernandes MS
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  9. Joaquim Gama-Rodrigues MD, PhD
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Correspondence to Rodrigo Oliva Perez MD, PhD.

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Perez, R.O., Habr-Gama, A., São Julião, G.P. et al. Transanal Endoscopic Microsurgery (TEM) Following Neoadjuvant Chemoradiation for Rectal Cancer: Outcomes of Salvage Resection for Local Recurrence. Ann Surg Oncol 23, 1143–1148 (2016). https://doi.org/10.1245/s10434-015-4977-2

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  • DOI: https://doi.org/10.1245/s10434-015-4977-2

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