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Long-term outcomes of transanal endoscopic microsurgery for clinical complete response after neoadjuvant treatment in T2-3 rectal cancer

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Abstract

Background

Organ sparing by the transanal endoscopic microsurgery (TEM) procedure is a treatment for patients with locally advanced rectal cancer after chemoradiotherapy (CRT) and complete clinical response (cCR).

Aims

To assess the surgical and long-term oncological outcomes of TEM for the treatment in T2-3 rectal cancer after CRT and cCR.

Methods

This study was a retrospective review of a prospective database of patients with rectal cancer who underwent TEM after CRT and cCR from April 2011 to March 2020.

Results

52 patients underwent TEM during a period of 9 years. This group of patients included 27 females and 25 males. The median age was 62 (32–86) years, lesion size was 2.5 (1–4) cm, and lesion distance from the anal verge 7.3 (4–10) cm. Median operative time was 79.5 (25–120) min and hospital stay was 1 day (14 h–4 days). Morbidity rate was 13.5% and reoperation rate due to major complications was 3.8%. Final histological findings confirmed 34 (65.4%) patients with ypT0, 7 (13.5%), 6 (11.5%), and 5 (9.6%) patients with carcinoma ypT1, ypT2, and ypT3, respectively. After a median follow-up period of 86 (5–107) months, 1 (2.4%) patient had local recurrences and 3 (7.3%) distant metastases. The 5-year disease-free survival was 91.7% and 5-year overall survival 89.5%.

Conclusion

Our experience has shown significant rates of ypT0 and ypT1 associated with excellent long-term results. Performing TEM to treat T2-3N0 rectal cancer after CRT and cCR appears to be an oncologically safe and effective procedure.

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Acknowledgements

The authors would like to acknowledge Professor Berta Moinelo Plasencia, B.A., for reviewing the English version of this article, and the staff of the National Center for Minimally Invasive Surgery in Cuba for helping the authors complete the study.

Funding

Drs. Javier Ernesto Barreras González, Haslen Cáceres Lavernia, Jorge Gerardo Pereira Fraga, and Solvey Quesada Lemus have no corporate/commercial relationships with pharmaceutical or device companies that might pose a conflict of interest with this manuscript. No consultant ships, honoraria, stock ownership, gifts, free or reimbursed travel/vacations, equity interests, arrangements regarding patents, or other vested interests.

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  1. Department of Laparoscopic and Endoscopic Surgery, National Center for Minimally Invasive Surgery, Havana Medical University, Párraga Street 315, 10 de Octubre, Havana, Cuba

    Javier Ernesto Barreras González, Jorge Gerardo Pereira Fraga & Solvey Quesada Lemus

  2. Department of Medical Oncology, University Hospital “Hermanos Ameijeiras”, Havana Medical University, Havana, Cuba

    Haslen Cáceres Lavernia

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  1. Javier Ernesto Barreras González
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Correspondence to Javier Ernesto Barreras González.

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Drs. Javier Ernesto Barreras González, Haslen Cáceres Lavernia, Jorge Gerardo Pereira Fraga, and Solvey Quesada Lemus hereby transfer, assign, or otherwise convey all copyright ownership, including any rights incidental there to, exclusively to the journal, in the event that such work is published by the journal. Drs. Javier Ernesto Barreras González, Haslen Cáceres Lavernia, Jorge Gerardo Pereira Fraga, and Solvey Quesada Lemus have no conflicts of interest or financial ties to disclose.

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González, J.E.B., Lavernia, H.C., Fraga, J.G.P. et al. Long-term outcomes of transanal endoscopic microsurgery for clinical complete response after neoadjuvant treatment in T2-3 rectal cancer. Surg Endosc 36, 2906–2913 (2022). https://doi.org/10.1007/s00464-021-08583-y

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