Transanal Endoscopic Microsurgery after Preoperative Concurrent Chemoradiation Therapy in Selected Distal Rectal Cancer Patients.
- Author:
Chi Min PARK
1
;
Keuk Won JUNG
;
Sang Ah HAN
;
Seong Hyeon YUN
;
Woo Yong LEE
;
HoKyung CHUN
Author Information
1. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. hkchun@smc.samsung.co.kr
- Publication Type:Original Article
- Keywords:
Rectal cancer;
Transanal endoscopic microsurgery;
Preoperative concurrent chemoradiation therapy;
Local excision
- MeSH:
Fluorouracil;
Follow-Up Studies;
Humans;
Microsurgery*;
Rectal Neoplasms*;
Recurrence;
Ultrasonography
- From:Journal of the Korean Society of Coloproctology
2005;21(5):293-299
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Preoperative concurrent chemoradiation (CCRT) therapy may allow higher rates of tumor resectability and sphincter-saving procedures. Transanal endoscopic microsurgery (TEM) has become increasingly common in the management of selected patients with early rectal cancer. The aim of this study is to evaluate the clinical outcomes of selected patients with distal rectal cancer treated with TEM after CCRT. METHODS: Between June 2000 and August 2004, 7 patients with clinically T2 or T3 rectal cancer underwent TEM after CCRT. Pretreatment and preoperative clinical stages were estimated by using endorectal ultrasound or computed tomography and digital rectal exam. CCRT was performed with radiation therapy of 4,500 cGy/25 fractions over 5 weeks with 5-FU based chemosensitization. TEM was performed 4~7 weeks following the completion of therapy. RESULTS: The mean age was 54.9 (35~70) years and the median follow-up period was 23.0 (5~57) months. The lesions were located between 2 to 6 cm above the anal verge (median 3.0 cm). Pre- treatment T staging was estimated as T3 in 1 case and T2 in 6 cases, and post-treatment T staging was estimated as complete remission (CR) in 2 cases, T1 in 3 cases, and T2 in 2 patients. Pathologic evaluation revealed tumor downstaging in 6 patients, including 3 patients (42.9%) with CR. In all cases, there was no tumor on the resection margin. There have been no recurrences during the follow-up period. CONCLUSIONS: TEM after CCRT therapy appears to be an effective alternative treatment to radical resection for highly selected patients with T2 and T3 distal rectal cancer.
