Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery (CARTS study)

Mareille Verseveld, EJR Graaf, Kees Verhoef, Esther van Meerten, CJA Punt, IHJT de Hingh, ID Nagtegaal, J.J.M.E. Nuyttens, CAM Marijnen, JHW (Johannes) de Wilt

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Abstract

BackgroundThis prospective multicentre study was performed to quantify the number of patients with minimal residual disease (ypT0-1) after neoadjuvant chemoradiotherapy and transanal endoscopic microsurgery (TEM) for rectal cancer. MethodsPatients with clinically staged T1-3N0 distal rectal cancer were treated with long-course chemoradiotherapy. Clinical response was evaluated 6-8 weeks later and TEM performed. Total mesorectal excision was advocated in patients with residual disease (ypT2 or more). ResultsThe clinical stage was cT1N0 in ten patients, cT2N0 in 29 and cT3N0 in 16 patients. Chemoradiotherapy-related complications of at least grade 3 occurred in 23 of 55 patients, with two deaths from toxicity, and two patients did not have TEM or major surgery. Among 47 patients who had TEM, ypT0-1 disease was found in 30, ypT0N1 in one, ypT2 in 15 and ypT3 in one. Local recurrence developed in three of the nine patients with ypT2 tumours who declined further surgery. Postoperative complications grade I-IIIb occurred in 13 of 47 patients after TEM and in five of 12 after (completion) surgery. After a median follow-up of 17 months, four local recurrences had developed overall, three in patients with ypT2 and one with ypT1 disease. ConclusionTEM after chemoradiotherapy enabled organ preservation in one-half of the patients with rectal cancer. Organ preservation feasible
Original languageUndefined/Unknown
Pages (from-to)853-860
Number of pages8
JournalBritish Journal of Surgery
Volume102
Issue number7
DOIs
Publication statusPublished - 2015

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