title: Long-term results of transanal excision after neoadjuvant chemoradiation for T2 and T3 adenocarcinomas of the rectum.
abstract: BACKGROUND
  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 (NCR) 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 NCR.
  
  
  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 NCR. Fifteen patients were deemed medically unfit for radical resection, and 29 would have required abdominoperineal resection but were opposed to colostomy.
  
  
  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). Thirty-one patients had a clinical complete response (cCR) to NCR of which 19 (61%) had a pathologic CR (pCR). Seven (16%) of 44 patients sustained disease recurrence of which two were local only, two local and systemic, and three systemic only. Only four (9%) patients had died of disease at current follow up. Overall 5-year survival rates for T2/T3N0 and T2/T3N1 patients were 84% and 81%, respectively. Five patients underwent radical resection 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 NCR 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.
authors: Division of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, WCB-2, Tampa, FL 33612-9497, USA.
authors: Rajesh M
authors: RM
authors: Nair
authors: Erin M
authors: EM
authors: Siegel
authors: Dung-Tsa
authors: DT
authors: Chen
authors: William J
authors: WJ
authors: Fulp
authors: Timothy J
authors: TJ
authors: Yeatman
authors: Mokenge P
authors: MP
authors: Malafa
authors: Jorge
authors: J
authors: Marcet
authors: David
authors: D
authors: Shibata
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000601:surgery / Q000628:therapy*; D012007:Rectum / Q000601:surgery; D016896:Treatment Outcome