Annals of Surgical Oncology

, Volume 23, Issue 4, pp 1143–1148 | Cite as

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

  • Rodrigo Oliva PerezEmail author
  • Angelita Habr-Gama
  • Guilherme Pagin São Julião
  • Igor Proscurshim
  • Laura Melina Fernandez
  • Rafael Ulysses de Azevedo
  • Bruna B. Vailati
  • Felipe Alexandre Fernandes
  • Joaquim Gama-Rodrigues
Colorectal Cancer



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.


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.


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 %.


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.


Local Recurrence Total Mesorectal Excision Ultralow Anterior Resection Salvage Resection Total Mesorectal Excision Specimen 
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No financial disclosures.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Rodrigo Oliva Perez
    • 1
    • 2
    • 3
    Email author
  • Angelita Habr-Gama
    • 1
    • 4
  • Guilherme Pagin São Julião
    • 1
  • Igor Proscurshim
    • 1
  • Laura Melina Fernandez
    • 1
  • Rafael Ulysses de Azevedo
    • 1
    • 4
  • Bruna B. Vailati
    • 1
  • Felipe Alexandre Fernandes
    • 1
    • 4
  • Joaquim Gama-Rodrigues
    • 1
    • 4
  1. 1.Angelita and Joaquim Gama InstituteSão PauloBrazil
  2. 2.Colorectal Surgery DivisionUniversity of São Paulo School of MedicineSão PauloBrazil
  3. 3.São Paulo BranchLudwig Institute for Cancer ResearchSão PauloBrazil
  4. 4.University of São Paulo School of MedicineSão PauloBrazil

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