Transanal endoscopic microsurgery (T.E.M) treatment of rectal cancer: A comparision of outcomes with and without neoadjuvant radiation therapy

Introduction: Improved tumor downstaging and complete response rates of rectal cancer treated with neoadjuvant therapy have been observed. There has been concern that the detrimental, local effect of radiation makes this approach unsuitable for excision. We compared 2 groups of patients undergoing comparable TEM surgery, with and without neoadjuvant radiation.

Methods: All patients undergoing TEM for rectal cancer with intent to cure from 11/97 to 06/07 were prospectively entered in a database. Demographics and perioperative information were captured. The neoadjuvant group was treated with a mean dose of 5175 cGy (4000-5580 cGy) and concurrent 5FU based chemo was used preferentially. Surgery was performed at a median of 9 weeks following completion of treatment (4-16 weeks).

Results: 64 patients with rectal cancer were treated with TEM; 43 with neoadjuvant (XRT) therapy and 21 with TEM alone. Patient characteristics for the XRT group were: age 67 years (29-86), 13 women. In the non-XRT group, age was 66 years (49-89) and 9 women. The pre-operative and pathologic T stage was: XRT patients: T0: 0/15, T1: 2/5, T2: 31/18, T3: 10/5. Non-XRT patients: T0: 10/5, T1: 9/9, T2: 2/6, T3: 0/1. There were no mortalities in either group. Overall morbidity rate for the XRT was 30% and 14% for the non-XRT group, this difference was statistically different (p0.05). There was one patient with a positive margin in each group, 2.3% from the XRT and 4.8% for non-XRT (p


Session: Podium Presentation

Program Number: S065

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