Yu Sato, MD, PhD, Takashi Oshiro, MD, PhD, Tomoaki Kitahara, MD, Yutaka Yoshida, MD, Tasuku Urita, MD, Ryuichi Takagi, MD, Kentaro Kawamitsu, MD, Kengo Kadoya, MD, Taiki Nabekura, MD, Shin-Ichi Okazumi, MD, PhD. Department of Surgery, Toho University Sakura Medical Center
Introduction: In elderly patients with cancer, radical surgery is sometimes not selected because of their vulnerabilities. For cases of rectal cancer, total mesorectal excision has been regarded as a standard therapy. However, it can cause some lethal complications and impair the quality of life. Local excision (LE) for low to mid rectal cancer in elderly patients with T1/T2 lesions is an attractive therapeutic method. This study revealed the outcomes of our conventional transanal LE and evaluated the benefit of transanal minimally invasive surgery (TAMIS) for the treatment of T1/T2 rectal cancer in elderly patients.
Methods and Procedures: Fifteen patients with low rectal tumors underwent conventional non-endoscopic transanal LE at our institution between January 2012 and December 2016. After this period, TAMIS was applied to the LE in elderly patients with T1/T2 rectal cancer, and chemoradiation (45 Gy plus 1650 mg/m2 of capecitabine per day) was administered to those who were pathologically diagnosed as possessing high-risk factors for lymph node metastasis. We presented 3 cases of this treatment.
Results: In the cohort of conventional transanal LE, the range of tumor location was 1 to 5 cm from the anal verge. Piecemeal resection of the tumor was performed in 2 patients. Postoperative bleeding occurred in 1 patient. Six patients (40%) had positive or unevaluable margins, and 3 patients (20%) had recurrences. Among the TAMIS group, en bloc full-thickness resection with clear margins was possible in all patients. No intraoperative or postoperative complications occurred, and anal function after treatment was retained as that before surgery. One patient had a pT2 tumor with lymphatic invasion and received adjuvant radiotherapy, but he developed distant recurrences 3 months after surgery. On the other hand, 2 patients had pT1 cancer and were followed-up observationally without any additional treatment. Both patients did not show evidence of recurrence.
Conclusions: TAMIS followed by chemoradiotherapy was demonstrated to be safe for elderly patients with T1/T2 rectal cancer. While long-term oncological outcomes are limited, this treatment might be less invasive for vulnerable patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92436
Program Number: P277
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster