title: Complementary use of local excision and transanal endoscopic microsurgery for rectal cancer after neoadjuvant chemoradiation.
abstract: BACKGROUND
  Neoadjuvant therapies have significantly improved local control and survival of patients with rectal cancer. Nevertheless, although a complete pathologic response can be achieved in 30% of cases, a transabdominal surgical resection is always required. This study aimed, for the first time, to test in the literature the feasibility of local excision combined with transanal endoscopic microsurgery (TEM) as a surgical option for patients treated with neoadjuvant chemoradiation.
  
  
  METHODS
  Between July 1997 and December 2002, 30 patients with rectal cancer affected by an extraperitoneal tumor entered a protocol consisting of neoadjuvant chemoradiation followed by surgery. The surgical treatment, consisting of open surgery, local excision, or TEM, was planned according to the patient's clinical response after chemoradiation and distance from the anal verge.
  
  
  RESULTS
  A significant clinical downstaging was observed in eight patients. Five of these patients underwent TEM, and three had local excision. Consequently, open surgery was performed for 22 patients. Histology showed six cases of complete pathologic response: three in the open surgery group and three in the transanal excision group. After a mean follow-up period of 47 months, the disease-free survival rate was 77% in the open surgery group and 100% in TEM or local excision group.
  
  
  CONCLUSIONS
  The findings suggest the complementary feasibility of TEM and local excision after neoadjuvant chemoradiation. However, randomized trials are needed to confirm the oncologic safety of this approach.
authors.affiliation: Department of Surgery, Campus Bio-Medico University Rome Italy, Via Longoni 47, 00155, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Caricato
authors.forename: D
authors.initials: D
authors.lastname: Borzomati
authors.forename: F
authors.initials: F
authors.lastname: Ausania
authors.forename: G
authors.initials: G
authors.lastname: Tonini
authors.forename: C
authors.initials: C
authors.lastname: Rabitti
authors.forename: S
authors.initials: S
authors.lastname: Valeri
authors.forename: L
authors.initials: L
authors.lastname: Trodella
authors.forename: V
authors.initials: V
authors.lastname: Ripetti
authors.forename: R
authors.initials: R
authors.lastname: Coppola
mesh_terms: D000368:Aged; D001003:Anal Canal; D017024:Chemotherapy, Adjuvant; D013505:Digestive System Surgical Procedures; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011300:Preoperative Care; D011351:Proctoscopy / Q000379:methods; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome