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International Journal of Colorectal Disease

, Volume 27, Issue 6, pp 759–764 | Cite as

A prospective analysis of patient outcome following treatment of T3 rectal cancer with neo-adjuvant chemoradiotherapy and transanal excision

  • Rory P. Kennelly
  • Anna Heeney
  • Anne White
  • David Fennelly
  • Kieran Sheahan
  • John M. P. Hyland
  • P. Ronan O’Connell
  • Desmond C. Winter
Original Article

Abstract

Background

Local excision is an alternative to anterior or abdomino-perineal resection in patients with early rectal cancer. In more advanced disease, neo-adjuvant therapy (CRXT) can result in significant disease regression such that local excision may be considered. The primary aim was to assess oncological outcome in patients with T3 rectal cancer treated with CRXT and local excision due to unsuitability for or aversion to anterior resection and stoma. The secondary aim was to examine oncological outcomes in patients treated in a similar way in the published literature.

Methods

Between July 2006 and July 2009, patients with rectal cancer staged T3, N0/N1, M0 who were deemed unfit for or who refused anterior resection were offered long-course CRXT. Patients were restaged 8 weeks following completion. If there was a good response (regression grade 2 or 3 clinically and radiologically), full thickness transanal excision was performed. All patients were followed regularly (monthly CT abdomen/pelvis and annual endoscopy) to assess for recurrence of disease. A literature search of PubMed was performed to identify all prospective data available of T3 rectal cancers managed with CRXT and local excision.

Results

Ten patients were treated over 3 years. Six patients had complete pathological response, while four patients had a partial response. The resection margins following local excision were clear in all. There was no local recurrence (median follow-up 24 months, range 9–42 months).

Conclusion

Neo-adjuvant chemoradiotherapy and local excision is an option in patients unfit for or averse to major surgical resection if there is a good response to CRXT.

Keywords

Neo-adjuvant therapy Local excision T3 rectal cancer 

Notes

Conflict of interest

The authors state that they have no conflict of interest.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Rory P. Kennelly
    • 1
  • Anna Heeney
    • 1
  • Anne White
    • 1
  • David Fennelly
    • 2
  • Kieran Sheahan
    • 3
  • John M. P. Hyland
    • 1
  • P. Ronan O’Connell
    • 1
  • Desmond C. Winter
    • 1
  1. 1.Department of Surgery, St. Vincent’s University Hospital and School of Medicine and Medical SciencesUniversity College DublinDublin 4Ireland
  2. 2.Department of Oncology, St. Vincent’s University Hospital and School of Medicine and Medical SciencesUniversity College DublinDublin 4Ireland
  3. 3.Department of Pathology, St. Vincent’s University Hospital and School of Medicine and Medical SciencesUniversity College DublinDublin 4Ireland

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