title: Multicentre study of short-course radiotherapy and transanal endoscopic microsurgery for early rectal cancer.
abstract: BACKGROUND
  Organ-preserving treatment for early-stage rectal cancer may avoid the substantial perioperative morbidity and functional sequelae associated with total mesorectal excision (TME). The initial results of an organ-preserving approach using preoperative short-course radiotherapy (SCRT) and transanal endoscopic microsurgery (TEMS) are presented.
  
  
  METHODS
  Patients with cT1-2N0 rectal cancers staged using high-quality MRI and endorectal ultrasonography received SCRT, with TEMS 8-10 weeks later, at four regional referral centres between 2007 and 2013. Patients were generally considered high risk for TME surgery (a small number refused TME).
  
  
  RESULTS
  Following SCRT and TEMS, 60 (97 per cent) of 62 patients had an R0 resection. Histopathological staging identified 20 ypT0 tumours, 23 ypT1, 18 ypT2 and one ypT3. Preoperative uT category was significantly associated with a complete pathological response, which was achieved in 13 of 27 patients with uT0/uT1 disease and in five of 29 with uT2 (P = 0·010). Acute complications affected 19 patients, the majority following TEMS. No fistulas occurred and no stomas were formed. Surveillance detected four intraluminal local recurrences at a median follow-up of 13 months, all in patients with tumours staged as ypT2. Salvage TME achieved R0 resection in three patients and a stent was placed in one patient owing to co-morbidities.
  
  
  CONCLUSIONS
  SCRT with TEMS was effective in the majority of patients considered high risk for (or who refused) TME surgery.
authors.affiliation: Departments of Surgery, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Smart
authors.affiliation: Department of Surgery, Good Hope Hospital, Sutton Coldfield, UK.
authors.forename: S
authors.initials: S
authors.lastname: Korsgen
authors.affiliation: Department of Surgery, Manchester Royal Infirmary, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hill
authors.affiliation: Department of Surgery, Western General Hospital, Edinburgh, UK.
authors.forename: D
authors.initials: D
authors.lastname: Speake
authors.affiliation: Department of Surgery, St Richard's Hospital, Chichester, UK.
authors.forename: B
authors.initials: B
authors.lastname: Levy
authors.affiliation: Department of Surgery, Bradford Royal Infirmary, Bradford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Steward
authors.affiliation: Departments of Clinical Oncology, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: J I
authors.initials: JI
authors.lastname: Geh
authors.affiliation: Department of Surgery, Bradford Royal Infirmary, Bradford, UK.
authors.forename: J
authors.initials: J
authors.lastname: Robinson
authors.affiliation: St James Institute of Oncology, Leeds, UK.
authors.forename: D
authors.initials: D
authors.lastname: Sebag-Montefiore
authors.affiliation: Departments of Surgery, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Bach
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D019583:Dose Fractionation, Radiation; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D059351:Organ Sparing Treatments; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D000067369:Transanal Endoscopic Microsurgery; D006113:United Kingdom / Q000453:epidemiology