title: Pitfalls of transanal endoscopic microsurgery for rectal cancer following neoadjuvant chemoradiation therapy.
abstract: Transanal endoscopic microsurgery has become a very useful surgical tool for the management of selected cases of rectal cancer. However, the considerably high local recurrence rates led to the introduction of neoadjuvant therapies including radiation with or without chemotherapy. This treatment strategy may result in significant rates of tumor regression allowing the procedure to be offered to a significant proportion of cases. On the other hand, neoadjuvant chemoradiation (CRT) may also determine wound-healing difficulties with significant postoperative pain. In addition, salvage total mesorectal excision in the case of local recurrence may also be a challenging task. Finally, accurate selection criteria for this minimally invasive approach are still lacking and may be influenced by baseline staging, post-treatment staging and final pathology information. Ultimately, selection of patients for this treatment modality remains a significant challenge for the colorectal surgeon who should be aware of the pitfalls of this procedure in the setting of neoadjuvant CRT.
authors.affiliation: Angelita & Joaquim Gama Institute/Hospital Alemão Oswaldo Cruz , São Paulo , Brazil.
authors.forename: Angelita
authors.initials: A
authors.lastname: Habr-Gama
authors.forename: Guilherme Pagin
authors.initials: GP
authors.lastname: São Julião
authors.forename: Rodrigo Oliva
authors.initials: RO
authors.lastname: Perez
mesh_terms: D001003:Anal Canal; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000601:surgery*; D014945:Wound Healing