title: Transanal endoscopic operation for rectal cancer after neoadjuvant therapy.
abstract: OBJECTIVE
  In this paper we report the oncological outcomes from clinical series of patients with rectal cancer submitted to local excision after neoadjuvant therapy and discuss the indications for local excision in partial clinical responders.
  
  
  METHODS
  We analysed a prospective database of 39 patients submitted to a transanal endoscopic operation for rectal cancer after neoadjuvant chemoradiation between 2006 and 2015, comparing clinical and pathological variables, perioperative complications, recurrence rate and overall survival.
  
  
  RESULTS
  We obtained 15.4% ypT0, 17.9% ypT1, 35.9% ypT2 and 28.2% ypT3. After a median follow-up of 24 months, tumoral recurrence was observed in 4 patients, one of them with isolated pulmonary metastasis. R0 resection was achieved in 79.5%, and postoperative complications were observed in 30.2% patients and no perioperative mortality occur. Compromise surgical margins do not affect recurrence rate, and 94.9% of patients are alive nowadays.
  
  
  CONCLUSIONS
  Local excision could be associated with low recurrence rate and good overall survival. Short hospitalization time and low level of serious complications observed could be an interesting option for patients who would not tolerate a radical procedure or for those who declined a total mesorectal excision. A strict long-term follow-up must be warranted to detect early tumoral recurrence.
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: José Joaquim Ribeiro da
authors.initials: JJ
authors.lastname: Rocha
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Mário Vinícius Angelete Alvarez
authors.initials: MV
authors.lastname: Bernardes
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Marley Ribeiro
authors.initials: MR
authors.lastname: Feitosa
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Camila
authors.initials: C
authors.lastname: Perazzoli
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Vanessa Foresto
authors.initials: VF
authors.lastname: Machado
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Fernanda Maris
authors.initials: FM
authors.lastname: Peria
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Harley Francisco de
authors.initials: HF
authors.lastname: Oliveira
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Omar
authors.initials: O
authors.lastname: Feres
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods / Q000401:mortality; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D000067368:Transanal Endoscopic Surgery / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome