Long-Term Results of Transanal Excision After Neoadjuvant Chemoradiation for T2 and T3 Adenocarcinomas of the Rectum
详细信息 查看全文
- 作者：Rajesh M. Nair (1)
Erin M. Siegel (2)
Dung-Tsa Chen (3)
William J. Fulp (3)
Timothy J. Yeatman (1)
Mokenge P. Malafa (1)
Jorge Marcet (4)
David Shibata (1) - 关键词：Rectal cancer ; Local excision ; Neoadjuvant chemoradiation
- 刊名：Journal of Gastrointestinal Surgery
- 出版年：2008
- 出版时间：October 2008
- 年：2008
- 卷：12
- 期：10
- 页码：1797-1806
- 全文大小：208KB
- 参考文献：1. Nastro P, Beral D, Hartley J, Monson JR. Local excision of rectal cancer: review of literature. Dig Surg 2005;22(1-):6-5. doi:10.1159/000084345 . CrossRef
2. Sengupta S, Tjandra JJ. Local excision of rectal cancer: what is the evidence? Dis Colon Rectum 2001;44(9):1345-361. doi:10.1007/BF02234796 . CrossRef
3. Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff RD, Rothenberger DA. Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg 2000;231(3):345-51. doi:10.1097/00000658-200003000-00007 . CrossRef
4. Madbouly KM, Remzi FH, Erkek BA, Senagore AJ, Baeslach CM, Khandwala F, et al. Recurrence after transanal excision of T1 rectal cancer: should we be concerned? Dis Colon Rectum 2005;48(4):711-19. (discussion 719-1). doi:10.1007/s10350-004-0666-0 . CrossRef
5. Chakravarti A, Compton CC, Shellito PC, Wood WC, Landry J, Machuta SR, et al. Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg 1999;230(1):49-4. doi:10.1097/00000658-199907000-00008 . CrossRef
6. Lezoche E, Guerrieri M, Paganini A, Feliciotti F, Di Pietrantonj F. Is transanal endoscopic microsurgery (TEM) a valid treatment for rectal tumors? Surg Endosc 1996;10(7):736-41.
7. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 2000;43(8):1064-071. (discussion 1071-074). doi:10.1007/BF02236551 . CrossRef
8. Minsky BD, Rich T, Recht A, Harvey W, Mies C. Selection criteria for local excision with or without adjuvant radiation therapy for rectal cancer. Cancer 1989;63(7):1421-429. doi:10.1002/1097-0142(19890401)63:7<1421::AID-CNCR2820630732>3.0.CO;2-H . CrossRef
9. Greenberg JA, Shibata D, Herndon JE 2nd, Steele GD Jr., Mayer R, Bleday R. Local excision of distal rectal cancer: an update of cancer and leukemia group B 8984. Dis Colon Rectum 2008;51(8):1185-191. CrossRef
10. Steele GD Jr, Herndon JE, Bleday R, Russell A, Benson A 3rd, Hussain M, et al. Sphincter-sparing treatment for distal rectal adenocarcinoma. Ann Surg Oncol 1999;6(5):433-41. doi:10.1007/s10434-999-0433-5 . CrossRef
11. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351(17):1731-740. doi:10.1056/NEJMoa040694 . CrossRef
12. Chari RS, Tyler DS, Anscher MS, Russell L, Clary BM, Hathorn J, et al. Preoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum. Ann Surg 1995;221(6):778-86. (discussion 786-87). doi:10.1097/00000658-199506000-00016 . CrossRef
13. Chen ET, Mohiuddin M, Brodovsky H, Fishbein G, Marks G. Downstaging of advanced rectal cancer following combined preoperative chemotherapy and high dose radiation. Int J Radiat Oncol Biol Phys 1994;30(1):169-75.
14. Janjan NA, Khoo VS, Abbruzzese J, Pazdur R, Dubrow R, Cleary KR, et al. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys 1999;44(5):1027-038. doi:10.1016/S0360-3016(99)00099-1 .
15. Minsky BD, Cohen AM, Kemeny N, Enker WE, Kelsen DP, Reichman B, et al. Combined modality therapy of rectal cancer: decreased acute toxicity with the preoperative approach. J Clin Oncol 1992;10(8):1218-224.
16. Kim CJ, Yeatman TJ, Coppola D, Trotti A, Williams B, Barthel JS, et al. Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg 2001;234(3):352-58. (discussion 358-59). doi:10.1097/00000658-200109000-00009 . CrossRef
17. Charlson ME, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-83. doi:10.1016/0021-9681(87)90171-8 . CrossRef
18. Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-81. doi:10.2307/2281868 . CrossRef
19. Heintz A, Morschel M, Junginger T. Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc 1998;12(9):1145-148. doi:10.1007/s004649900802 . CrossRef
20. Palma P, Freudenberg S, Samel S, Post S. Transanal endoscopic microsurgery: indications and results after 100 cases. Colorectal Dis 2004;6(5):350-55. doi:10.1111/j.1463-1318.2004.00671.x . j.1463-1318.2004.00671.x">CrossRef
21. Varma MG, Rogers SJ, Schrock TR, Welton ML. Local excision of rectal carcinoma. Arch Surg 1999;134(8):863-67. (discussion 867-68). doi:10.1001/archsurg.134.8.863 . CrossRef
22. Winde G, Nottberg H, Keller R, Schmid KW, Bunte H. Surgical cure for early rectal carcinomas (T1). Transanal endoscopic microsurgery vs. anterior resection. Dis Colon Rectum 1996;39(9):969-76. doi:10.1007/BF02054683 . CrossRef
23. Habr-Gama A, de Souza PM, Ribeiro U Jr, Nadalin W, Gansl R, Sousa AH Jr, et al. Low rectal cancer: impact of radiation and chemotherapy on surgical treatment. Dis Colon Rectum 1998;41(9):1087-096. doi:10.1007/BF02239429 . CrossRef
24. Endreseth BH, Myrvold HE, Romundstad P, Hestvik UE, Bjerkeset T, Wibe A. Transanal excision vs. major surgery for T1 rectal cancer. Dis Colon Rectum 2005;48(7):1380-388. doi:10.1007/s10350-005-0044-6 . CrossRef
25. Zieren HU, Jacobi CA, Zieren J, Muller JM. Assessment of quality of life after resection of colorectal carcinoma. Chirurg 1996;67(7):703-08. (discussion 709).
26. Enker WE, Havenga K, Polyak T, Thaler H, Cranor M. Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer. World J Surg 1997;21(7):715-20. doi:10.1007/s002689900296 . CrossRef
27. Enker WE, Merchant N, Cohen AM, Lanouette NM, Swallow C, Guillem J, et al. Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg 1999;230(4):544-52. (discussion 552-54). doi:10.1097/00000658-199910000-00010 . CrossRef
28. Rothenberger DA, Wong WD. Abdominoperineal resection for adenocarcinoma of the low rectum. World J Surg 1992;16(3):478-85. doi:10.1007/BF02104451 . CrossRef
29. Averbach AM, Chang D, Koslowe P, Sugarbaker PH. Anastomotic leak after double-stapled low colorectal resection. Dis Colon Rectum 1996;39(7):780-87. doi:10.1007/BF02054444 . CrossRef
30. Williamson ME, Lewis WG, Finan PJ, Miller AS, Holdsworth PJ, Johnston D. Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma: myth or reality? Dis Colon Rectum 1995;38(4):411-18. doi:10.1007/BF02054232 . CrossRef
31. Petrelli NJ, Nagel S, Rodriguez-Bigas M, Piedmonte M, Herrera L. Morbidity and mortality following abdominoperineal resection for rectal adenocarcinoma. Am Surg 1993;59(7):400-04.
32. Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U Jr, Silva e Sousa AH Jr, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 2004;240(4):711-17. (discussion 717-18).
33. Habr-Gama A, Perez RO, Proscurshim I, Campos FG, Nadalin W, Kiss D, et al. Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg 2006;10(10):1319-328. (discussion 1328-329). doi:10.1016/j.gassur.2006.09.005 . j.gassur.2006.09.005">CrossRef
34. Guillem JG, Chessin DB, Shia J, Moore HG, Mazumdar M, Bernard B, et al. Clinical examination following preoperative chemoradiation for rectal cancer is not a reliable surrogate end point. J Clin Oncol 2005;23(15):3475-479. doi:10.1200/JCO.2005.06.114 . CrossRef
35. Maldjian C, Smith R, Kilger A, Schnall M, Ginsberg G, Kochman M. Endorectal surface coil MR imaging as a staging technique for rectal carcinoma: a comparison study to rectal endosonography. Abdom Imaging 2000;25(1):75-0. doi:10.1007/s002619910015 . CrossRef
36. Calvo FA, Domper M, Matute R, Martinez-Lazaro R, Arranz JA, Desco M, et al. 18F-FDG positron emission tomography staging and restaging in rectal cancer treated with preoperative chemoradiation. Int J Radiat Oncol Biol Phys 2004;58(2):528-35. doi:10.1016/j.ijrobp.2003.09.058 .
37. Delrio P, Lastoria S, Avallone A, Ravo V, Guida C, Cremona F, et al. Early evaluation using PET-FDG of the efficiency of neoadjuvant radiochemotherapy treatment in locally advanced neoplasia of the lower rectum. Tumori. 2003;89(Suppl 4):50-3.
38. Gagliardi G, Bayar S, Smith R, Salem RR. Preoperative staging of rectal cancer using magnetic resonance imaging with external phase-arrayed coils. Arch Surg 2002;137(4):447-51. doi:10.1001/archsurg.137.4.447 . CrossRef
39. Kuo LJ, Chern MC, Tsou MH, Liu MC, Jian JJ, Chen CM, et al. Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy. Dis Colon Rectum 2005;48(1):23-8. doi:10.1007/s10350-004-0787-5 . CrossRef
40. Tulchinsky H, Rabau M, Shacham-Shemueli E, Goldman G, Geva R, Inbar M, et al. Can rectal cancers with pathologic T0 after neoadjuvant chemoradiation (ypT0) be treated by transanal excision alone? Ann Surg Oncol 2006;13(3):347-52. doi:10.1245/ASO.2006.03.029 . CrossRef
41. Bedrosian I, Rodriguez-Bigas MA, Feig B, Hunt KK, Ellis L, Curley SA, et al. Predicting the node-negative mesorectum after preoperative chemoradiation for locally advanced rectal carcinoma. J Gastrointest Surg 2004;8(1):56-2. (discussion 62-3). doi:10.1016/j.gassur.2003.09.019 . j.gassur.2003.09.019">CrossRef
42. Hiotis SP, Weber SM, Cohen AM, Minsky BD, Paty PB, Guillem JG, et al. Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: an analysis of 488 patients. J Am Coll Surg 2002;194(2):131-35. (discussion 135-36). doi:10.1016/S1072-7515(01)01159-0 . CrossRef
43. Medich D, McGinty J, Parda D, Karlovits S, Davis C, Caushaj P, et al. Preoperative chemoradiotherapy and radical surgery for locally advanced distal rectal adenocarcinoma: pathologic findings and clinical implications. Dis Colon Rectum 2001;44(8):1123-128. doi:10.1007/BF02234632 . CrossRef
44. Onaitis MW, Noone RB, Fields R, Hurwitz H, Morse M, Jowell P, et al. Complete response to neoadjuvant chemoradiation for rectal cancer does not influence survival. Ann Surg Oncol 2001;8(10):801-06. doi:10.1007/s10434-001-0801-2 . CrossRef
45. Pucciarelli S, Capirci C, Emanuele U, Toppan P, Friso ML, Pennelli GM, et al. Relationship between pathologic T-stage and nodal metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer. Ann Surg Oncol 2005;12(2):111-16. doi:10.1245/ASO.2005.03.044 . CrossRef
46. Stipa F, Zernecke A, Moore HG, Minsky BD, Wong WD, Weiser M, et al. Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: rationale for radical resection? Ann Surg Oncol 2004;11(2):187-91. doi:10.1245/ASO.2004.06.010 . CrossRef
47. Lezoche E, Guerrieri M, Paganini AM, Baldarelli M, De Sanctis A, Lezoche G. Long-term results in patients with T2- N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg 2005;92(12):1546-552. doi:10.1002/bjs.5178 . js.5178">CrossRef
48. Bonnen M, Crane C, Vauthey JN, Skibber J, Delclos ME, Rodriguez-Bigas M, et al. Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients. Int J Radiat Oncol Biol Phys 2004;60(4):1098-105. doi:10.1016/j.ijrobp.2004.04.062 .
49. Caricato M, Borzomati D, Ausania F, Tonini G, Rabitti C, Valeri S, et al. Complementary use of local excision and transanal endoscopic microsurgery for rectal cancer after neoadjuvant chemoradiation. Surg Endosc 2006;20(8):1203-207. doi:10.1007/s00464-005-0567-x . CrossRef
50. Ruo L, Guillem JG, Minsky BD, Quan SH, Paty PB, Cohen AM. Preoperative radiation with or without chemotherapy and full-thickness transanal excision for selected T2 and T3 distal rectal cancers. Int J Colorectal Dis 2002;17(1):54-8. doi:10.1007/s003840100327 . CrossRef
51. Schell SR, Zlotecki RA, Mendenhall WM, Marsh RW, Vauthey JN, Copeland EM 3rd. Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy. J Am Coll Surg 2002;194(5):584-90. (discussion 590-91). doi:10.1016/S1072-7515(02)01128-6 . CrossRef
52. Das P, Skibber JM, Rodriguez-Bigas MA, Feig BW, Chang GJ, Hoff PM, et al. Clinical and pathologic predictors of locoregional recurrence, distant metastasis, and overall survival in patients treated with chemoradiation and mesorectal excision for rectal cancer. Am J Clin Oncol 2006;29(3):219-24. doi:10.1097/01.coc.0000214930.78200.4a . CrossRef
53. Wexner SD, Rotholtz NA. Surgeon influenced variables in resectional rectal cancer surgery. Dis Colon Rectum 2000;43(11):1606-627. doi:10.1007/BF02236751 . CrossRef
54. Lezoche G, Baldarelli M, Guerrieri M, Paganini AM, De Sanctis A, Bartolacci S, et al. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 2008;22(2):352-58. doi:10.1007/s00464-007-9596-y . CrossRef
55. Borschitz T, Wachtlin D, Mohler M, Schmidberger H, Junginger T. Neoadjuvant chemoradiation and local excision for T2- rectal cancer. Ann Surg Oncol 2008;15(3):712-20. doi:10.1245/s10434-007-9732-x . CrossRef
56. Paty PB, Nash GM, Baron P, Zakowski M, Minsky BD, Blumberg D, et al. Long-term results of local excision for rectal cancer. Ann Surg 2002;236(4):522-29. (discussion 529-30). doi:10.1097/00000658-200210000-00015 . CrossRef - 作者单位：Rajesh M. Nair (1)
Erin M. Siegel (2)
Dung-Tsa Chen (3)
William J. Fulp (3)
Timothy J. Yeatman (1)
Mokenge P. Malafa (1)
Jorge Marcet (4)
David Shibata (1)
1. Division of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, WCB-2, Tampa, FL, 33612-9497, USA
2. Risk Assessment, Detection and Intervention Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
3. Biostatistics Core Facility of the Department of Interdisciplinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
4. Department of Surgery, University of South Florida College of Medicine, Tampa, FL, USA
文摘
Introduction Traditionally, selected early distal rectal cancers have been considered for treatment by transanal excision (TAE) with acceptable oncologic results. With the frequent use of neoadjuvant chemoradiation (NCR) for the treatment of locally advanced rectal cancer, there is growing interest in the application of TAE for such lesions. We report our experience of TAE for T2 and T3 rectal cancers following NCR. Material and Methods Between July 1994 and August 2006, 44 patients were identified as having undergone full-thickness TAE of pretreatment ultrasound-staged T2 and T3 rectal cancers that were treated with NCR. Fifteen patients were deemed medically unfit for radical resection, and 29 would have required abdominoperineal resection but were opposed to colostomy. Results Our patient population consisted of 26 men and 18 women, with a median age of 69 (range, 43-9) and a median follow up of 64?months (6-53). Thirty-one patients had a clinical complete response (cCR) to NCR of which 19 (61%) had a pathologic CR (pCR). Seven (16%) of 44 patients sustained disease recurrence of which two were local only, two local and systemic, and three systemic only. Only four (9%) patients had died of disease at current follow up. Overall 5-year survival rates for T2/T3N0 and T2/T3N1 patients were 84% and 81%, respectively. Five patients underwent radical resection immediately following TAE for either positive margins or residual cancer. There was minimal morbidity with no perioperative mortality associated with TAE. Conclusions TAE of T2 and T3 rectal cancers following NCR is a safe alternative to radical resection in a highly select group of patients for which recurrence and survival rates comparable to radical resection can be achieved. This study supports ongoing efforts to assess this approach in prospective, multi-center trials.