Resumen de Further evidence for preoperative chemoradiotherapy and transanal endoscopic surgery (TEM) in T2-3s,N0,M0 rectal cancer
Carles Pericay Pijaume, Xavier Serra Aracil, J. Ocaña Rojas, Laura Mora López, Emma Dotor Navarro, A. Casalots, Aleydis Pisa Gatell, Eugeni Saigí Grau
Purpose Preoperative chemoradiotherapy and local excision via transanal endoscopic surgery (TEM) in T2–3s,N0,M0 rectal cancer achieve promising results in selected patients. We describe our long-term follow-up experience with this combination, and evaluate complete clinical and pathological responses, local recurrence and overall survival.
Methods The prospective observational follow-up study carried out since 2007. Out of 476 consecutive patients treated with TEM, we selected those with adenocarcinoma of low or moderate grade of differentiation, clinical stages T2-superficial T3,N0,M0, who refused radical surgery. Preoperative chemoradiotherapy comprised 5-fluorouracil or capecitabine combined with radiotherapy at a dose of 50.4 Gy. TEM was performed after 8 weeks. Complications were recorded and long-term follow-up was conducted.
Results Fifteen patients undergoing preoperative chemoradiotherapy and TEM (median age 76 years, 95 % CI 70.3–80.4, and median follow-up 38 months, 95 % CI 20–44) were studied. No local recurrence was observed, and only one patient (6.7 %) presented systemic relapse. The overall survival was 76 %. Complete clinical response was achieved in seven patients (46.7 %) and complete pathological response in four (26.7 %). With regard to toxicity associated with neoadjuvant treatment, four patients (26.7 %) developed grade 3 adverse effects; no grade 4 or 5 adverse effects were observed. There was no postoperative mortality.
Conclusions The results of our study, with a response rate of 26.7 % and without local relapse, support the treatment of T2–3s,N0,M0 of rectal cancer with preoperative chemoradiotherapy and local excision (TEM).
