直肠癌新辅助治疗联合保肛手术34例分析

目的探讨新辅助放化疗联合保肛手术治疗局部进展期直肠癌的安全性。方法回顾性分析2007年6月至2009年6月期间我科收治的34例T3、T4期低位直肠癌采用新辅助放化疗联合保肛手术治疗患者的临床资料。常规分割放疗,总剂量40Gy,每周5次,每次2Gy。于第4周放疗结束后开始行全身化疗,1个疗程,方案为奥沙利铂(150mg/d1)、亚叶酸钙(100mg/d1～3)加5-FU(750mg/d1～3)。于新辅助治疗结束后4周进行手术。结果经新辅助治疗后,肿瘤直径平均缩小41.2%,67.6%(23/34)的病例T分期下降,淋巴结阴转率为58.8%(10/17)。术后无吻合口漏发生,发生肝转移1例,局部复发1例;88.2%(30/34)患者术后肛门功能良好。结论对局部进展期直肠癌患者采用新辅助放化疗,能使肿瘤分期降低;联合行保肛手术,不增加手术并发症的发生率,安全、有效。     

新辅助放化疗联合盆腔脏器切除术治疗45例复发性直肠癌

目的：探讨新辅助放化疗联合盆腔脏器切除术在复发性直肠癌治疗中的价值。方法：对45例复发直肠癌患者采用新辅助放化疗方案治疗常规分割放疗,治疗结束后4～6周进行盆腔脏器切除手术。结果：经新辅助放化疗后,病理完全缓解9例,肿瘤平均缩小38.4%,68.9%的病例T期下降。全组R0切除率为82.2%,手术并发症为20.0%,3年生存率为80.0%,5年生存率为44.4%。结论：新辅助放化疗联合盆腔脏器切除术是治疗复发性直肠癌的有效方法,通过降低肿瘤病期,提高手术切除率,从而提高患者生存率。     

新辅助治疗低位进展期直肠癌15例疗效观察

目的 探讨新辅助治疗在低位进展期直肠癌中的临床价值。方法 2003年1月-2006年12月对我科治疗的15例低位进展期直肠癌患者采用新辅助治疗,常规分割化疗,术前放射总剂量为45 Gy,每周5次,每次1.8 Gy,同时联合奥沙利铂、亚叶酸钙、5-FU同步化疗,放化疗结束6周后行手术治疗。结果 经过新辅助治疗后,1例肿瘤完全消失,未行手术治疗,肿瘤平均缩小40.5%,73.3%的病例T期降期,7例行保肛的直肠癌根治术,保肛率53.3%,Miles手术5例,2例行Hartmann手术。结论 低位进展期直肠癌患者接受新辅助治疗后,可使肿瘤病理降期,切除率增加,提高保肛率,同时副作用小,患者耐受性较好。     

局部进展期直肠癌新辅助化放疗的疗效观察

目的观察新辅助治疗对局部进展期直肠癌的疗效。方法2003年5月至2008年12月,我院临床分期为T3／T4期的局部进展期直肠癌病例32例,术前接受化疗一放疗一化疗,化放疗结束4～6周后手术。术后用Dworak分级评估新辅助治疗的组织学反应。所有患者术后接受随访,观察并发症发生率、局部复发率和临床结局。结果本组32例皆为R0切除,其中21例低位前切除术（Dixon术）,11例腹会阴联合切除术（MiLe术）,保肛率为65．6％。术后病检：5例Dworak分级3级,3例Dworak分级2级,24例Dworak分级1级。32例术后全部随访,随访时间24～91个月,中位随访时间52个月。全组无局部复发病例,皆无瘤生存至今。结论局部进展期直肠癌术前新辅助治疗有益,但对术后生存率的影响有待进一步观察。     

新辅助联合治疗在低位直肠癌的应用及存在的问题

目的探讨新辅助联合治疗（术前放化疗）、全直肠系膜切除（total mesorectal excision,TME）在局部进展期低位直肠癌的治疗效果。方法2003年1月至2007年12月,将49例T3、T4期的低位直肠癌给予放疗总剂量44~50Gy,每次2Gy,每周5次,共5周 同时常规给予5-FU＋MMC持续静脉滴注,放疗结束后休息6周进行手术。手术均按TME操作规范进行。结果全部病例均按计划完成新辅助联合治疗,放化疗的副反应发生率为26.5%（3/49）,3例肿瘤完全消失,未行手术。46例施行了根治性切除术,40例为保肛手术,6例为腹会阴切除术,故全组保肛率为87.8%（43/49）。已切除的标本病理结果显示8例肿瘤消失（T0）,总肿瘤消失为11例。辅助治疗后TNM分期：T0N0M011例,T2N0M022例,T3N0M04例,T2N1M07例,T3N1M04例,T4N1M11例,共40例（81.6%）达到降期。全组均获随访,中位随访时间24（6~38）个月。1例（2.0%）局部复发,1例（2.0%）肝转移,无死亡,3例未行手术的患者随访8~26个月至今,仍未发现肿瘤复发。结论新辅助联合治疗与TME相结合能有效地提高肿瘤的切除率和保肛率,降低局部复发率,达到肿瘤降期的目的,进一步降低了术后复发的风险,其远期疗效尚待进一步观察。     

新辅助治疗联合盆腔脏器切除术治疗复发直肠癌

目的探讨新辅助治疗联合盆腔脏器切除术对复发直肠癌的临床治疗价值。方法对35例复发直肠癌患者,采用新辅助治疗方案。常规分次放疗,放疗总剂量(DT)46Gy,每周5次,每次2Gy。全身化疗2个疗程,每次予以奥沙利铂130mg/m2,第1天静脉点滴;甲酰四氢叶酸钙(CF)200mg/m2,第1~3天静脉点滴;氟脲嘧啶(5-Fu)500mg/m2,第1~3天静脉点滴。治疗结束后4~6周进行盆腔脏器切除手术。结果经新辅助治疗后,病理完全缓解6例,肿瘤平均缩小38.4%,65.7%的病例T期下降。全组无手术死亡,R0切除率为88.5%,手术并发症发生率为13.3%。本组总的3年生存率为82.8%;5年生存率为48.5%;其中获得R0切除的患者,3年生存率为90.3%,5年生存率为54.6%。结论新辅助治疗联合盆腔脏器切除术是治疗复发直肠癌的有效方法。通过降低肿瘤病期,提高手术切除率,从而提高患者生存率。     

新辅助治疗对进展期直肠癌术后淋巴结获取数目的影响

目的 探讨新辅助治疗对中下段局部进展期直肠癌术后淋巴结获取数目的 影响.方法 回顾性研究2005年1月至2008年6月120例行根治手术切除的中下段进展期直肠癌[T2-4和(或)N1-2M0]病例的临床资料.患者中行新辅助治疗联合手术切除者54例(研究组),直接行根治性手术切除者66例(对照组),新辅助治疗的手段包括术前总剂量50 Gy的盆腔放疗和5-Fu为基础的同步化疗.根据患者临床病理分期等特点,比较新辅助治疗前后临床分期的变化,比较两组总淋巴结获取数和阳性淋巴结获取数的差别.结果 研究组新辅助治疗后,30例(56%)出现了T分期或N分期的降期;对照组的总淋巴结数为(14±7)个、阳性淋巴结数为(2.2±3.7)个,而研究组中手术标本获取的总淋巴结数为(9±6)个、阳性淋巴结数(0.7±2.4)个,均明显少于对照组(P＜0.01).结论 新辅助治疗在降低肿瘤T分期的同时,可以明显降低直肠癌术后的区域淋巴结获取率和阳性淋巴结的获取率;对于接受了新辅助治疗的直肠癌病例,获取尽可能多的评估淋巴结是有必要的.     

术前对进展期直肠癌进行放化疗可使肿瘤分期下降、出现完全病理反应,降低局部复发率并提高无病生存期

术前放化疗在直肠癌的治疗中已被广泛应用 ,新辅助治疗反应的前瞻性价值尚不清楚。局部进展期直肠癌是指肿瘤侵犯肠壁和侵犯直肠周围淋巴结 ,作者对 88例 B超分期为 T3/T4的中低位局部进展期直肠癌 (中位 37例 ,低位 5 1例 ;63例男性 ,平均年龄 62 .6岁 )在术前进行以 5 - Fu ( 2 5 0～ 40 0mg/m2·d-1,第一周给药 3～ 5 d,放疗第 5周时再给药 1周期 ,部分病人加用左旋咪唑 )为基础的化疗 ,并对盆腔进行放疗 (总放射剂量为 45 0 0 c Gy,分2 5次 ,共 5周 ) ,6周或更长时间后进行手术 (前切除术或经腹会阴联合切除术 )。术后将病理分期与术…     

直肠癌新辅助放化疗后CEA水平的临床意义

本研究旨在评估直肠癌新辅助放化疗后CEA水平的临床意义。收集109例接受术前放化疗联合根治性切除术的直肠癌患者。术前血清CEA水平分别在接受放化疗之前和放化疗结束4周后进行检测。在新辅助放化疗结束后6-9周实施手术。本组患者3年无瘤生存率为85．0％。应用单因素分析发现如下指标与无瘤生存期有关：放化疗前CEA水平、     

浸润深度对T3期直肠癌患者新辅助放化疗治疗效果的预测

目的探讨T3期直肠癌患者肿瘤浸润深度与新辅助放化疗疗效的关系,以便为T3期直肠癌患者提供个体化治疗方案。方法回顾性分析2010年1月至2012年12月复旦大学附属肿瘤医院接受新辅助放化疗加手术治疗的73例T3期直肠癌患者。比较高分辨MRI测量下肿瘤侵犯超过直肠固有肌层的最远深度,即T3a（小于5mm）、T3b（5～10mm）和T3c（大于10mm）患者与新辅助放化疗疗效的关系。结果高分辨率MRI测量下肿瘤浸润深度（T3a、T3b和T3c）与新辅助放化疗治疗反应（完全反应、中度反应和低度反应）具有明显相关性（r=0．30,P=0．010）,其中T3a期患者病理完全缓解（pER）率为42．9％（6／14）,明显高于T3b期的14．9％（7／47）和T3c期的0（P=0．017）。结论MRI评估为T3a期的直肠癌患者经过新辅助放化疗后较,T3b和T3c期患者更易获得pER;肿瘤侵犯超过直肠固有肌层小于5mm可作为正向预测因子对T3期直肠癌进行分层,指导后续治疗。     

Response to chemoradiotherapy and lymph node involvement in locally advanced rectal cancer

AIM: To establish the association between lymph node involvement and the response to neoadjuvant therapy in locally advanced rectal cancer.METHODS: Data of 130 patients with mid and low locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiation followed by radical surgery over a 5-year period were reviewed. Tumor staging was done by endorectal ultrasound and/or magnetic resonance imaging. Tumor response to neoadjuvant therapy was determined by T-downstaging and tumor regression grading (TRG). Pathologic complete response (pCR) is defined as the absence of tumor cells in the surgical specimen (ypT0N0). The varying degrees TRG were classified according to Mandard’s scoring system. The evaluation of the response is based on the comparison between previous clinico-radiological staging and the results of pathological evaluation. χ² and Spearman’s correlation tests were used for the comparison of variables.RESULTS: Pathologic complete response (pCR, ypT0N0, TRG1) was observed in 19 cases (14.6%), and other 18 (13.8%) had only very few residual malignant cells in the rectal wall (TRG2). T-downstaging was found in 63 (48.5%). Mean lymph node retrieval was 9.4 (range 0-38). In 37 cases (28.5%) more than 12 nodes were identified in the surgical specimen. Preoperative lymph node involvement was seen in 77 patients (59.2%), 71 N1 and 6 N2. Postoperative lymph node involvement was observed in 41 patients (31.5%), 29 N1 and 12 N2, while the remaining 89 were N0 (68.5%). In relation to ypT stage, we found nodal involvement of 9.4% in ypT0-1, 22.2% in ypT2 and 43.7% in ypT3-4. Of the 37 patients considered “responders” to neoadjuvant therapy (TRG1 and 2), there were only 4 N+ (10.8%) and the remainder N0 (89.2%). In the “non responders” group (TRG 3, 4 and 5), 37 cases were N+ (39.8%) and 56 (60.2%) were N0 (P < 0.001).CONCLUSION: Response to neoadjuvant chemoradiation in rectal cancer is associated with lymph node involvement.     

Clinically-Staged T3N0 Rectal Cancer: Is Preoperative Chemoradiotherapy the Optimal Treatment?

Background

Preoperative chemoradiotherapy has been widely adopted as the standard of care for stage II–III rectal cancers. However, patients with T3N0 lesions had been shown to have a better prognosis than other categories of locally advanced tumor. Thus, neoadjuvant chemoradiation is likely to be overtreatment in this subgroup of patients. Nevertheless, the low accuracy rate of preoperative staging techniques for detection of node-negative tumors does not allow to check this hypothesis. We analyzed a group of patients with cT3N0 low rectal cancer who underwent neoadjuvant chemoradiotherapy with the purpose of evaluating the incidence of metastatic nodes in the resected specimens.

Methods

Between January 2002 and February 2008, 100 patients with low rectal cancer underwent clinical staging by means of endorectal ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging. All patients received preoperative 5-fluorouracil-based chemoradiotherapy and surgical resection with curative aim.

Results

Of 100 patients with locally advanced rectal cancer, 32 were clinically staged as T3N0M0. Pathological analysis showed the presence of lymph node metastases in nine patients (28%) (node-positive group). In the remaining 23 cases, clinical N stage was confirmed at pathology (node-negative group). Node-positive and node-negative groups differ only in the number of ypT3 tumors (P < .01).

Conclusions

Our results indicate that immediate surgery for patients with cT3N0 rectal cancer represents an undertreatment risk in at least 28% of cases, making necessary the use of postoperative chemoradiotherapy. Preoperative chemoradiotherapy should be the therapy of choice on the grounds of the principle that overtreatment is less hazardous than undertreatment for cT3N0 rectal cancers.     

新辅助放化疗在局部进展期低位直肠癌中的疗效

目的探讨新辅助放化疗对局部进展期低位直肠癌的治疗效果。方法2001年5月至2005年8月共收治105例局部进展期（T3、T4期）低位直肠癌患者,术前给予中等剂量放疗40—46Gy,分次剂量2Gy／d,每周5d,共4—5周完成放疗;放疗开始同时给予卡培他滨1250mg·m^-2·d^-1,分2次I=I服,持续服用至手术。放疗结束后休息6周进行手术,手术均按直肠系膜全切除操作规范进行。结果全组105例患者均按计划完成预定的放化疗。其中36例出现各种不良反应,但Ⅲ级不良反应仅见2例手足综合征。13例患者放化疗后经复查后提示肿瘤消失未行手术。其余92例患者则施行了根治性手术,其中低位前切除术71例,结肠肛管吻合术（Parks术）17例,腹会阴切除术4例,全组总保肛率为96．2％。术后标本病理检查显示11例未见癌细胞及阳性淋巴结。肿瘤TNM分期为TON0者24例,T2N0者23例,BNo者43例,T4N0者2例,T2N1者5例,T3N1者8例;按Dworak肿瘤消退分级,TGR05例,TGR129例,TGR247例,TGR324例。全组共有82例（78．1％）达到降期。全组无手术死亡,术后出现3例直肠阴道漏,2例吻合口漏。所有患者均获随访,随访时间为16—67个月。随访期间肺转移4例,肝转移2例,局部复发4例,其中3例死亡。全组病死率为2．9％,3年无瘤生存率为82．8％,3年总生存率为96．5％。结论新辅助放化疗可有效达到肿瘤降期的目的,提高了局部进展期低位直肠癌的根切率和保肛率,进一步降低了局部复发率和总复发率,并明显提高了无瘤生存率和总生存率。     

经新辅助或转化治疗术后分期为ypT0~1NanyM0局部进展期胃癌54例预后分析

目的 分析经新辅助或转化治疗术后分期为ypT0~1NanyM0的局部进展期胃癌病人的长期预后。方法 回顾性分析2008年1月至2020年1月中国人民解放军东部战区总医院普外科收治的经新辅助或转化治疗后行根治性切除手术，且术后分期为ypT0~1NanyM0的54例局部进展期胃癌病人的临床资料，应用Kaplan-Meier法计算病人3年和5年的总体生存率及无进展生存率，并比较术后分期为ypT0N0M0与ypT1N0M0病人之间的生存差异。结果 共纳入54例局部进展期胃癌病人。10例（18.5%）病人术前接受常规给药途径的SOX化疗方案，44例采用动静脉结合的化疗方法，其中31例（57.4%）为SEEOX方案，13例（24.1%）为FLEEOX方案。所有病人均实施D2或D2+淋巴结清扫，并获得R0切除。30例（55.6%）病人行全胃切除术，24例（44.4%）行远端胃切除术。术后分期为ypT0N0M0病人38例（70.4%），ypT1N0M0病人11例（20.4%）。所有病人术后均接受辅助化疗。随访56.5（13.1～170.3）个月，共有15例病人死亡，其中11例病人因肿瘤局部复发或远处转移死亡，复发转移时间为18.9（7.8～55.5）个月。3年和5年总体生存率分别为83.2%和76.4%，3年和5年无进展生存率分别为83.1%和72.8%。分期为ypT0N0M0与ypT1N0M0病人生存时间比较结果显示，总体生存时间［中位生存时间为尚未达到（NR） vs. 5.2年，HR=0.46，95%CI 0.12-1.68，P=0.138］和无进展生存时间（NR vs 4.6年，HR=0.57，95%CI 0.15-2.20，P=0.337）差异均无统计学意义。结论 经新辅助或转化治疗术后分期为ypT0~1NanyM0 的局部进展期胃癌病人长期预后较好，且ypT1N0M0与ypT0N0M0病人的长期生存时间相近。     

Local excision for ypT2 rectal cancer--much ado about something.

BACKGROUND: The role of local excision for pT2 distal rectal cancer has been challenged because of the observation of high rates of lymph node metastases and local failure. However, neoadjuvant chemoradiation therapy (CRT) has led to increased local disease control and significant tumor downstaging, possibly decreasing rates of lymph node metastases. In this setting, a possible role for local excision of ypT2 has been suggested. METHODS: A total of 401 patients with distal rectal cancer underwent neoadjuvant CRT. Tumor response assessment was performed after at least 8 weeks from CRT completion. One hundred and twelve patients with complete clinical response were not immediately operated on and were excluded from the study, and 289 patients with incomplete clinical response were managed by radical surgery. Patients with final pathological stage ypT2 were analyzed to determine the risk of unfavorable pathological features that could represent unacceptable risk for local failure after local excision. RESULTS: Eighty-eight (30%) patients had ypT2 rectal cancer. Final ypT status was not associated with pretreatment radiological staging (p = 0.62). ypT status was significantly associated with the risk of lymph node metastases, risk of perineural and vascular invasion, and recurrence (p = 0.001). Lymph node metastases were present in 19% of patients with ypT2 rectal cancer. The risk of lymph node metastases in ypT2 was associated with the presence of perineural invasion (47% vs 4%; p = <0.001), vascular invasion (59% vs 6%; p < 0.001), and decreased mean interval CRT surgery (12 vs 18 weeks; p < 0.001), but not with mean tumor size (3.2 vs 3.1 cm; p = 0.8). Disease-free and overall survival rates were significantly better for patients with ypT2N0 (p = 0.02 and 0.006, respectively). Fifty-five (63%) patients with ypT2 had at least one unfavorable pathological feature for local excision (lymph node metastases, vascular or perineural invasion, mucinous type or tumor size >3 cm). CONCLUSION: Lymph node metastases were present in 19% of patients with ypT2 and were significantly associated with poor overall and disease-free survival rates. The risk of lymph node metastases could not be predicted by radiological staging or tumor size. Radical surgery should be considered the standard treatment option for ypT2 rectal cancer after CRT.     

CEA水平与进展期直肠癌新辅助放化疗疗效的关系

目的探讨癌胚抗原在预测进展期直肠癌对术前新辅助放化疗反应中的作用。方法对我院接受术前新辅助放化疗的48例进展期直肠癌分组,按照治疗前CEA的水平分为CEA升高组和CEA正常组,对切除术后标本进行分析,比较两组病例在肿瘤局部降期及肿瘤消退方面的差异。结果CEA升高组共21例,其中术后肿瘤降期（包括术后病理ypT02有12例,57％）,出现肿瘤消退（包括TGR2~4者11例,52％）CEA正常组共27例,其中术后肿瘤降期（包括术后病理ypT02有20例,74％）,出现肿瘤消退（包括TGR2~4者21例,78％）。CEA升高组肿瘤降期及消退比率均低于CEA正常组。结论治疗前CEA水平的升高可能预示直肠癌对术前新辅助放化疗的反应性差,有助于直肠癌患者个体化治疗方案的选择。     

中低位直肠癌新辅助放化疗后病理完全缓解预测因素分析

目的 探讨预测中低位直肠癌新辅助放化疗后病理完全缓解（pCR）的临床因素。方法 回顾性分析2013年1月至2016年10月中山大学附属第六医院收治的行新辅助放化疗联合全直肠系膜切除手术治疗的185例进展期中低位直肠癌病人的临床病理资料，包括年龄、治疗前癌胚抗原（CEA）、病理类型及分期、新辅助化疗方案、放疗结束至手术间隔时间等。根据肿瘤治疗反应分为pCR组（49例）和non-pCR组（136例），计算pCR率并分析其影响因素。结果 术后49例（26.5%）病人达到pCR，103例病人病理学疗效分级为0或1，总降期率为55.8%。单因素分析显示，肿瘤T分期（P=0.004）和N分期（P=0.032）、治疗前CEA水平（P=0.039）、化疗方案（P=0.003）与pCR相关；多因素分析显示，T2分期和化疗方案中含有奥沙利铂是pCR的独立影响因素。结论 T2分期和以氟尿嘧啶为基础同时联合奥沙利铂的化疗方案是影响中低位直肠癌新辅助放化疗pCR的独立预测因素。     

Progress report about the 1st Workshop on Local Excision of Rectal Cancer

To determine the significance of local excision (LE) of rectal cancer and discuss oncologic results, a 1st Workshop on LE of rectal cancer was held at the Department of General und Abdominal Surgery, Johannes Gutenberg-University Mainz, Germany. The option of broadening the indication for local excision after neoadjuvant radiochemotherapy (nRCT) of rectal cancer was to be assessed. Local excision of "low risk" T 1 carcinomas was rated as oncologically adequate therapy with good functional results and low complication rates. Transanal endoscopic microsurgical (TEM) resection was the preferrred technique. Pre-requisite for the achievement of low recurrence rates (5 %) is an R0 resection with a safety margin of at least 1 mm (R < or = 1 mm) without tumor fragmentation, because otherwise possible tumor cell displacement and RX resection may not allow an assessment of the resection margin. "high risk" tumors or T 2 carcinomas were not considered an indication for local excision. To identify additional histological risk factors for the oncological outcome (sm-level, tumor budding, mucinous component, perineural infiltration, etc.) the initiation of a multi-center register study (LERC = local excision of rectal cancer) was suggested and is now in preparation. If the finding after TEM resection is not a "low risk" T 1 carcinoma, but a "high risk" situation or a T 2 tumor, immediate reoperation is advised resulting in similar outcomes as compared to primary conventional surgery. A literature analysis of LE after neoadjuvant RCT of T 2/3 rectal cancers showed a local recurrence rate of 0 % for ypT 0 and of 5 % for ypT 1 findings (studies with small patient collectives and short follow-up periods). The lymph node status of T 2 / 3 carcinomas after nRCT is unclear. More advanced/primary not resectable tumors (T 3 / 4) showed lymph node metastases in 5 % for ypT 0 and in 12 % for ypT 1 findings after nRCT, suggesting that for earlier T categories lower rates can be expected. On the basis of these favourable results a prospective multi-center study will be initiated. A study protocol will be established during the 2nd Workshop on LE of rectal cancer in Mainz.     

Long-term Outcome of Local Excision after Complete Pathological Response to Neoadjuvant Chemoradiation Therapy for Rectal Cancer

Background

Neoadjuvant chemoradiotion therapy (CRT) for advanced rectal cancer has improved local disease. Complete rectal wall tumor regression may be associated with the absence of viable cancer cells in the mesorectum, and thus local excision (LE) of such lesions as an alternative to radical surgery has recently gained interest. We report the long-term outcome of LE in patients with a mural pathological complete response (ypT0) after CRT.

Methods

A retrospective review of patients with rectal cancer treated by CRT and followed by LE with pathological complete response in the specimen between 1998 and 2009 was performed.

Results

A total of 174 patients had neoadjuvant CRT, and 68 (39?%) showed complete clinical response (cCR). Thirty-one of the cCR patients underwent LE; 23 of them resulted in ypT0 and 8 had residual disease. The ypT0 group included 12 men and 11 women with a median age of 66. The pretreatment stage was T3N1 in 4 (17?%) patients, T3N0 in 11 (48?%), T2N1 in 3 (13?%), and T2N0 in 5 (22?%). The median tumor distance from the anal verge was 6?cm. Sixteen patients (70?%) underwent transanal excision, and 7 (30?%) were treated by transanal-endoscopic microsurgery. Three patients died: one of pneumonia, one of melanoma of the rectum, and one of lung carcinoma. No local or distant recurrences were detected in the remaining 20 patients. The median follow-up was 87?months.

Conclusions

Although radical rectal resection is the treatment of choice, LE of complete rectal tumor regression could be a safe alternative with an acceptable result in selected patients.