• early rectal cancer
• endoscopic surgery
• local excision
• safety and efficacy
• transanal endoscopic microsurgery

• Completion TME
• Early rectal cancer
• Local excision
• Snapshot study
• Surveillance

• Benign lesions
• Malignant lesions
• Radical surgery alternative
• Rectal lesions
• Transanal endoscopic microsurgery
• Young adults

• Early-stage rectal cancer
• Radical surgery
• Total mesorectal excision
• Transanal endoscopic microsurgery

• Humans
• Microsurgery/adverse effects
• Neoplasm Staging
• Rectal Neoplasms/pathology
• Rectum/surgery
• Retrospective Studies
• Transanal Endoscopic Microsurgery/adverse effects
• Treatment Outcome

• No. 02.05.22030036 the Jianghan Talent Funding

• Early cancer
• Oncological outcome
• Rectal cancer
• Surgical local excision

• Follow-up
• Local surgical resection
• Recurrence
• T1 rectal cancer
• Therapeutic endoscopy

• Humans
• Digestive System Surgical Procedures/methods
• Neoplasm Recurrence, Local/epidemiology
• Neoplasm Recurrence, Local/pathology
• Rectal Neoplasms/pathology
• Transanal Endoscopic Surgery
• Treatment Outcome

• Local excision
• Organ preservation
• Rectal cancer
• Transanal minimally invasive surgery

Background  Transanal endoscopic microsurgery (TEMS) has been suggested as an alternative to total mesorectal excision (TME) in the treatment of early rectal cancers. The extended role of TEMS for higher stage rectal cancers after neoadjuvant therapy is also experimented. The aim of this meta-analysis was to compare the oncological outcomes and report on the evidence-based clinical supremacy of either technique.

Methods  Medline, Embase, and Cochrane databases were searched for the randomized controlled trials comparing the oncological and perioperative outcomes of TEMS and a radical TME. A local recurrence and postoperative complications were analyzed as primary end points. Intraoperative blood loss, operation time, and duration of hospital stay were compared as secondary end points.

Results  There was no statistical difference in the local recurrence or postoperative complications with a risk ratio of 1.898 and 0.753 and p -values of 0.296 and 0.306, respectively, for TEMS and TME. A marked statistical significance in favor of TEMS was observed for secondary end points. There was standard difference in means of −4.697, −6.940, and −5.685 with p -values of 0.001, 0.005, and 0.001 for blood loss, operation time, and hospital stay, respectively.

Conclusion  TEMS procedure is a viable alternative to TME in the treatment of early rectal cancers. An extended role of TEMS after neoadjuvant therapy may also be offered to a selected group of patients. TME surgery remains the standard of care in more advanced rectal cancers.

• microsurgery
• rectal cancer
• total mesorectal excision

• Análisis de decisiones
• Cirugía completa
• Cirugía de rescate
• Cirugía radical
• Completion radiotherapy
• Completion surgery
• Cáncer de recto inicial
• Decision analysis
• Early rectal cancer
• Escisión local
• Local excision
• Radical surgery
• Radioterapia completa
• Revisión sistemática
• Salvage surgery
• Systematic review

• Clinical target volumes
• OP, organ preservation
• Organ Preservation
• RO, radiation oncologist
• Radiotherapy
• Rectal neoplasms
• WG, working group

• 19393 Cancer Research UK
• 28538 Cancer Research UK

Local excision (LE) is a feasible treatment approach for rectal cancers in stage pT1 and presents low pathological risk, whereas total mesorectal excision (TME) is a reasonable treatment for more advanced cancers. On the basis of the pathology findings, surgeons may suggest TME for patients receiving LE. This study compared the survival outcomes between LE with/without chemoradiation and TME in mid and low rectal cancer patients in stage pT1/pT2, with highly selective intermediate pathological risk.

This retrospective study included 134 patients who received TME and 39 patients who underwent LE for the treatment of intermediate risk (pT1 with poor differentiation, lymphovascular invasion, perineural invasion, relatively large tumor, or small-sized pT2 tumor) rectal cancer between 1998 and 2016.

Overall survival (OS), disease-free survival (DFS), and cumulative recurrence rate (CRR) were similar between the LE (3-year DFS 92%) and TME (3-year DFS 91%) groups. Following subgrouping into an LE with adjuvant therapy group and a TME without adjuvant therapy group, the compared survival outcomes (OS, DFS, and CRR) were found not to be statistically different. The temporary and permanent ostomy rates were higher in the TME group than in the LE group (p < 0.001). Rates of early and late morbidity following surgery were higher in the TME group (p = 0.005), and LE had similar survival compared with TME.

For patients who had mid and low rectal cancer in stage pT1/pT2 and intermediate pathological risk, LE with chemoradiation presents an alternative treatment option for selected patients.

• Chemoradiation
• Local excision
• Rectal cancer
• Sphincter-sparing surgery
• Total mesorectal excision

Thirty per cent of all colorectal tumours develop in the rectum. The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions. Most patients with early rectal cancer can be adequately managed by surgery alone. However, a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery. Neoadjuvant therapy involves a variety of options including radiotherapy, chemotherapy used alone or in combination. Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery. The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes, within an intact mesorectal package, in order to minimise local recurrence. It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties. Pre-operative staging including CT thorax, abdomen, pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential. Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy. While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure, which includes patients with nodal involvement, extramural venous invasion and threatened circumferential margin. The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.

• Rectal cancer
• Neoadjuvant therapy
• Low anterior resection syndrome
• Stoma
• Transanal endoscopic microsurgery
• Trans-anal total mesorectal excision
• Robotic surgery
• Watch and wait

• Disease-Free Survival
• Humans
• Lymph Node Excision
• Lymph Nodes/diagnostic imaging
• Lymph Nodes/pathology
• Lymph Nodes/radiation effects
• Magnetic Resonance Imaging
• Neoadjuvant Therapy/adverse effects
• Neoadjuvant Therapy/methods
• Neoplasm Recurrence, Local/epidemiology
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/prevention & control
• Neoplasm Staging
• Organs at Risk/radiation effects
• Patient Selection
• Preoperative Care/methods
• Proctectomy
• Radiation Injuries/epidemiology
• Radiation Injuries/etiology
• Rectal Neoplasms/mortality
• Rectal Neoplasms/pathology
• Rectal Neoplasms/therapy
• Rectum/pathology
• Rectum/radiation effects
• Rectum/surgery
• Tomography, X-Ray Computed
• Treatment Outcome
• Tumor Burden/radiation effects

• Adjuvant radiotherapy
• Local excision
• Rectal cancer
• Survival

• Adenocarcinoma/epidemiology
• Adenocarcinoma/pathology
• Adenocarcinoma/radiotherapy
• Adenocarcinoma/surgery
• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Radiotherapy, Adjuvant
• Rectal Neoplasms/epidemiology
• Rectal Neoplasms/pathology
• Rectal Neoplasms/radiotherapy
• Rectal Neoplasms/surgery
• Registries
• SEER Program
• Survival Rate
• United States/epidemiology

• Early rectal cancer
• Rectal cancer
• TEM-TAMIS-TME
• TME
• Transanal excision

• Rectal cancer
• endoluminal loco-regional resection
• local excision
• lymph node harvest
• sentinel lymph node
• transanal endoscopic microsurgery

• Laparoscopic surgery
• Minimally invasive surgery
• Rectal cancer
• Rectum
• Salvage surgery
• Transanal endoscopic microsurgery

• rectal cancer
• transanal endoscopic microsurgery
• transanal endoscopic surgery
• transanal minimally invasive surgery

• Causes of local recurrence
• Local recurrence
• Low-risk rectal carcinoma
• Transanal endoscopic microsurgery

• Rectal cancer
• liver acquisition with acceleration volume acquisition
• local recurrence
• magnetic resonance imaging

• Adult
• Aged
• Aged, 80 and over
• Contrast Media/therapeutic use
• Female
• Gadolinium/therapeutic use
• Humans
• Image Interpretation, Computer-Assisted/methods
• Liver/diagnostic imaging
• Magnetic Resonance Imaging/methods
• Male
• Middle Aged
• Neoplasm Recurrence, Local/diagnostic imaging
• Rectal Neoplasms/diagnostic imaging
• Young Adult

• local excision
• rectal polyp
• transanal endoscopic microsurgery
• transanal excision
• transanal minimally invasive surgery

Local excision is an organ-preserving treatment alternative for patients with stage I rectal cancer. However, local excision alone is associated with a high risk of local recurrence and inferior survival compared to transabdominal rectal resection. Here we investigate the oncologic and functional outcomes of neoadjuvant chemoradiotherapy and local excision for T2N0 rectal cancer.

This was a prospective, multi-institutional, single arm phase 2 trial for patients with clinically-staged T2N0 distal rectal cancer, treated with neoadjuvant chemoradiotherapy consisting of capecitabine (original dose 825mg/m², twice daily, on days 1-14 and 22-35) , oxaliplatin (50mg/m² weeks 1, 2, 4, 5), and radiation (5 days/week at 1.8 Gy/day for 5 weeks to a dose of 45 Gy, then a boost, for a total dose of 54 Gy) followed by local excision. Due to adverse events during chemoradiotherapy, the dose of capecitabine was reduced to 725 mg /m², twice daily, 5 days/week, for 5 weeks, and the total dose of radiation to 50.4 Gy. Patients were followed at scheduled intervals and evaluated for recurrence and survival. Anorectal function (ARF) and quality of life (QOL) were assessed at baseline and one year after surgery, using validated instruments. The primary endpoint was 3-year disease-free survival for all eligible patients and for patients who completed chemotherapy and radiation, and had ypT0, ypT1, or ypT2 tumors, and negative resection margins. This trial is registered with ClinicalTrials.gov, number NCT00114231.

Seventy-nine eligible patients were accrued to the trial, and started nCRT. Three patients did not complete nCRT or LE per-protocol. Four additional patients completed protocol treatment, but one had a positive margin and three had ypT3 tumours. Median follow-up was 56 months. Of the 79 patients, five (6%) developed distant recurrence, and three (4%) recurred locally. All but two underwent salvage surgery. Three-year disease-free survival and overall survival for the entire group were 88% (0.88 (95% CI: 0.81, 0.96) and 95% (95% CI: 0.90, 1.00), respectively. Overall 14 (29%) of 79 patients had grade 3-4 gastrointestinal adverse events, 12 (16%) of 79 patients had grade 3-4 pain as an adverse event, 12 (16%) of 79 patients had grade 3-4 hematological adverse events, and 9 (11%) of 79 patients had grade 3 dermatologic adverse events during chemoradiation. Six (8%) of the 77 patients who had surgery had grade 3 pain, 3(4%) of 77 patients had grade 3-4 hemorrhage, 3 (4%) of 77 patients had gastrointestinal adverse events, 2 (3%) of 77 patients had infectious/febrile neutropenia, 2 (3%) of 77 patients had hematological adverse events, and one (1%) had neurological adverse events. The rectum was preserved in 72 of the 79 (91%) patients. ARF and QOL were unchanged one year after surgery compared to baseline.

Most patients with T2N0 rectal cancer treated with nCRT and LE achieved organ preservation without deterioration of their quality of life. The estimated 3-year DFS rate was within the defined margin of efficacy. Our data suggest that nCRT followed by LE may be considered as an organ-preserving alternative in carefully selected patients with clinically-staged T2N0 tumours who refuse, or are not candidates for, transabdominal resection.

• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Adenocarcinoma/therapy
• Adult
• Aged
• Aged, 80 and over
• Chemoradiotherapy
• Digestive System Surgical Procedures
• Disease-Free Survival
• Female
• Humans
• Male
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Staging
• Organ Sparing Treatments
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Rectal Neoplasms/therapy
• Time Factors
• Treatment Outcome

• R01 CA182551 NCI NIH HHS
• U10 CA 76001 NCI NIH HHS
• U10 CA180821 NCI NIH HHS
• P30 CA008748 NCI NIH HHS
• U10 CA180882 NCI NIH HHS
• U10 CA076001 NCI NIH HHS

• Local resection
• Radical surgery
• Rectal cancer
• Transanal endoscopic microsurgery

• Adjuvant treatment
• Audit
• Colon cancer
• Consensus
• Delphi method
• Multidisciplinary teams
• Neoadjuvant treatment
• Quality assurance
• Rectal cancer
• Surgery

• abdominoperineal resection
• anterior resection
• lower rectal cancer
• transanal endoscopic microsurgery

• Adult
• Aged
• Aged, 80 and over
• Chi-Square Distribution
• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/mortality
• Digestive System Surgical Procedures/trends
• Female
• Guideline Adherence
• Humans
• Logistic Models
• Male
• Middle Aged
• Neoplasm Staging
• Odds Ratio
• Practice Guidelines as Topic
• Practice Patterns, Physicians'/trends
• Proportional Hazards Models
• Radiotherapy, Adjuvant
• Rectal Neoplasms/mortality
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Registries
• Risk Factors
• Standard of Care
• Time Factors
• Treatment Outcome
• United States/epidemiology

• T32 CA128590 NCI NIH HHS
• UL1 TR000083 NCATS NIH HHS
• T32 5T32CA128590-04 NCI NIH HHS
• UL1TR000083 NCATS NIH HHS

• Adenocarcinoma rectal
• Adenomas rectales
• Cirugía endoscópica transanal
• Rectal adenocarcinoma
• Rectal adenomas
• Transanal endoscopic surgery

The aim of this study was to analyze oncologic outcomes after transanal local excision (LE) to ensure adequate surveillance of recurrence in order to treat with curative intent.

Between January 2000 and June 2009, 102 patients who underwent transanal LE for rectal adenocarcinoma were retrospectively reviewed.

Of the 102 patients, 53 (52.0%) were male. The mean age was 57 ± 11 years. Postoperative pathologic examination revealed 93 cases (91.2%) of pathologic T stage (pT)1 and 9 cases (8.8%) of pT2. Forty-eight patients (47.1%) underwent adjuvant postoperative radiotherapy. The median follow-up interval was 60 months (range, 3 to 146 months). Seven (6.9%) out of 15 patients who suffered recurrence had locoregional recurrence, three (2.9%) had systemic recurrence and five (4.9%) had both systemic and locoregional recurrence. The latter five patients and two of the three patients with systemic recurrence died because of the disease recurrence. On the other hand, only one of the seven patients with locoregional recurrence died because of disease recurrence.

Systemic recurrence after transanal LE results in fatal consequences. Therefore, not only is it important to identify ideal candidates for LE, but intensive postoperative surveillance is important as well to identify curable recurrence as soon as possible.

• Local excision
• Rectal neoplasms

AIM: To identify the predictors of distant metastasis in pathologically T1 (pT1) colorectal cancer (CRC) after radical resection.

METHODS: Variables including age, gender, preoperative carcinoembryonic antibody (CEA) level, tumor location, tumor size, lymph node status, and histological grade were recorded. Patients with and without metastasis were compared with regard to age, gender, CEA level and pathologic tumor characteristics using the independent t test or χ² test, as appropriate. Risk factors were determined by logistic regression analysis.

RESULTS: Metastasis occurred in 6 (3.8%) of the 159 patients during a median follow-up of 67.0 (46.5%) mo. The rates of distant metastasis in patients with pT1 cancer of the colon and rectum were 6.7% and 2.9%, respectively (P < 0.001). The rates of distant metastasis between male and female patients with T1 CRC were 6.25% and 1.27%, respectively (P < 0.001). The most frequent site of distant metastasis was the liver. Age (P = 0.522), gender (P = 0.980), tumor location (P = 0.330), tumor size (P = 0.786), histological grade (P = 0.509), and high serum CEA level (P = 0.262) were not prognostic factors for lymph node metastasis. Univariate analysis revealed that age (P = 0.231), gender (P = 0.137), tumor location (P = 0.386), and tumor size (P = 0.514) were not risk factors for distant metastasis after radical resection for T1 colorectal cancer. Postoperative metastasis was only significantly correlated with high preoperative serum CEA level (P = 0.001). Using multivariate logistic regression analysis, high preoperative serum CEA level (P = 0.004; odds ratio 15.341; 95%CI 2.371-99.275) was an independent predictor for postoperative distant metastasis.

CONCLUSION: The preoperative increased serum CEA level is a predictive risk factor for distant metastasis in CRC patients after radical resection. Adjuvant chemotherapy may be necessary in such patients, even if they have pT1 colorectal cancer.

• Colorectal cancer
• Risk factor
• Metastasis
• Pathologically T1
• Carcinoembryonic antigen

• Aged
• Aged, 80 and over
• Biomarkers, Tumor/blood
• Carcinoembryonic Antigen/blood
• Colorectal Neoplasms/surgery
• Colorectal Surgery/methods
• Female
• Humans
• Logistic Models
• Lymphatic Metastasis/diagnosis
• Male
• Middle Aged
• Neoplasm Metastasis/diagnosis
• Predictive Value of Tests
• Preoperative Period
• Prognosis
• Retrospective Studies
• Risk Factors