Back to 2008 Program and Abstracts
Introduction:Traditionally, selected early distal rectal cancers have been considered for treatment by transanal excision (TAE) with acceptable oncologic results. With the frequent use of neoadjuvant chemoradiation (NC) for the treatment of locally advanced rectal cancer, there is growing interest in the application of TAE for such lesions. We report our experience of TAE for T2 and T3 rectal cancers following NC.Methods:Between July 1994 and August 2006, 44 patients were identified as having undergone full thickness TAE of pretreatment ultrasound-staged T2 and T3 rectal cancers that were treated with NC. Patients with a clinical complete response (CR) to preoperative treatment (n=31) were offered TAE as an alternative to standard radical resection. The remaining patients did not have a clinical CR and were either deemed medically unfit for (n=3) or refused (n=10) radical resection.Results:Our patient population consisted of 26 men and 18 women, with a median age of 69 (range 43-89) and a median follow up of 64 months (6-153). Of patients who had a clinical CR, 61% had a pathologic CR. Seven (16%) patients sustained disease recurrence of which 2 were local only, 2 local and systemic and 4 systemic only. Only 4 (9%) patients had died of disease at current follow up. Overall 5-year survival by stage was as follows (Table 1): 100% (8/8) for T2N0 patients; 72% (13/18) for T3N0 patients; and 71% (5/7) for T3N1 patients. Five patients underwent radical excision immediately following TAE for either positive margins or residual cancer. There was minimal morbidity with no perioperative mortality associated with TAE.Conclusions:TAE of T2 and T3 rectal cancers following NC is a safe alternative to radical resection in a highly select group of patients for which recurrence and survival rates comparable to radical resection can be achieved. This study supports ongoing efforts to assess this approach in prospective, multi-center trials.
Patient Characteristics
| Number of Patients | 44 |
| Pretreatment Tumor Diameter Mean (cm) | 3.3 ± 0.98 cm |
| Distance from Anal Verge Mean (cm) | 5.2 ± 2.1 cm |
| Differentiation Well Moderate Poor Not specified | 4 (9%)35 (80%)2 (4%)3 (7%) |
| Pretreatment Stage T2N0 T3N0 T2/3N1 Unknown | 10 (23%)22 (50%)11 (25%)1 (2%) |
| Clinical Response Complete Partial None | 31 (70%)11 (25%)2 (5%) |
| Pathologic Response Complete Partial None | 25 (57%)17 (39%)2 (5%) |
| Overall Survival 3 year 5 year | 32/39 (82%)26/34 (76%) |
| 5 year Overall Survival by Stage T2N0 T3N0 T2/3N1 | 8/8 (100%)13/18 (72%)5/7 (71%) |
| Disease-Specific Survival 3 year 5 year | 94%91% |
500 Cummings Center
+1 978-927-8330
+1 978-524-0498
