title: Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome.
abstract: BACKGROUND
  Transanal endoscopic microsurgery (TEM) after radiochemotherapy (RCT) has been reported in selected cases of locally advanced rectal cancer as an alternative to traditional radical resection with total mesorectal excision with a curative intent or as diagnostic tool to confirm a pathological complete response of the primary tumor. No study has evaluated functional outcome after TEM in preoperatively irradiated patients.
  
  
  METHODS
  This study was designed to evaluate short-term morbidity (according to Clavien's classifications) and establish (by a questionnaire) continence and evacuative function after RCT and TEM, at 1 year from surgery, analyzing the impact of RCT on postoperative outcomes. Patients with locally advanced rectal cancer treated by RCT and TEM (group 1) or with early T1 or adenomas treated only by TEM (group 2) entered this cohort comparative study.
  
  
  RESULTS
  Twenty-two patients entered the study as group 1 and 25 as group 2. No postoperative mortality occurred. The morbidity rate was 36.4 % in group 1 vs. 16 % in group 2 (p = 0.114). The rate of suture dehiscence was 22.7 % in group 1 vs. 4 % in group 2 (p = 0.068). No grade III complications, reoperation, or hospital readmission within 30 days was recorded in either group. One year after surgery, continence and evacuative scores in group 1 were 1.05 ± 1.25 and 24.72 ± 2.79, respectively, which were similar to group 2 (p = 0.081 and 0.288, respectively).
  
  
  CONCLUSIONS
  TEM after RCT in selected rectal cancer patients has an acceptable morbidity and functional results at 1 year from surgery. Preoperative irradiation could increase postoperative short-term morbidity, but it does not seem to influence evacuative or sphincter function after 1 year from surgery.
authors: Department of Surgical Sciences, Catholic University of Sacred Heart, Rome, Italy.
authors: C
authors: C
authors: Coco
authors: G
authors: G
authors: Rizzo
authors: C
authors: C
authors: Mattana
authors: M A
authors: MA
authors: Gambacorta
authors: A
authors: A
authors: Verbo
authors: B
authors: B
authors: Barbaro
authors: F M
authors: FM
authors: Vecchio
authors: D P
authors: DP
authors: Pafundi
authors: M G
authors: MG
authors: Mastromarino
authors: V
authors: V
authors: Valentini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000379:methods; D003672:Defecation / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D020360:Neoadjuvant Therapy; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012007:Rectum; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
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