Advances of Neoadjuvant Therapy Combined with Transanal Resection in Stage T 2-3 Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Su ¹ , YANG Tinghan ² , WANG Xiaodong ¹ , LI Li ¹

1.Center of Gastrointestinal Surgery, West China Hospital， Sichuan University, Chengdu 610041, China;;
2.West China Medical School， Sichuan University, Chengdu 610041, ChinaCorresponding Author: LI Li， E-mail: drlili116@126.com;

Corresponding?author：

Keywords：

Neoadjuvant chemoradiation; Transanal operation; Rectal cancer

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Objective 　To summarize the application and advancement of neoadjuvant therapy combined with transanal resection in stage T2-3 rectal cancer.
Methods 　Domestic and abroad publications on the studies of neoadjuvant therapy combined with transanal resection in stage T2-3 rectal cancer in recent years were collected and reviewed.
Results 　In selected patients with stage T2-3 rectal cancer, neoadjuvant therapy combined with transanal resection was efficacious in sphincter preservation and complications prevention. Compared with modality without chemoradiation, the recurrence rate had decreased from 17%-62% to 0-20%.
Conclusion 　Selected patients with stage T2-3 rectal cancer can benefit from neoadjuvant chemoradiation combined with transanal resection.

Citation： XU Su,YANG Tinghan,WANG Xiaodong,LI Li. Advances of Neoadjuvant Therapy Combined with Transanal Resection in Stage T 2-3 Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(4): 407-410. doi: Copy

1.	Anscher MS, Robertson CN, Prosnitz R. Adjuvant radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate: ten-year update [J]. Int J Radiat Oncol Biol Phys， 1995; 33(1): 37-43.
2.	Crane CH, Das P. Potential benefits of integration of therapies with chemoradiation in rectal cancer [J]. Gastrointest Cancer Res， 2007; 1(4 Suppl 2): S73-S80.
3.	Sengupta S, Tjandra JJ. Local excision of rectal cancer: what is the evidence? [J]. Dis Colon Rectum， 2001; 44(9): 1345-1361.
4.	Otmezguine Y, Grimard L, Calitchi E, et al. A new combined approach in the conservative management of rectal cancer [J]. Int J Radiat Oncol Biol Phys， 1989; 17(3): 539-545.
5.	Nastro P, Beral D, Hartley J, et al. Local excision of rectal cancer: review of literature [J]. Dig Surg， 2005; 22(1-2): 6-15.
6.	Borschitz T, Wachtlin D, Mhler M, et al. Neoadjuvant che-moradiation and local excision for T2-3 rectal cancer [J]. Ann Surg Oncol， 2008; 15(3): 712-720.
7.	National Comprehensive Cancer Network. NCCA Clinical pr-actice guidelines in oncology-rectal cancer, V.4.2008, http://www.nccn.org/professionals/physician_gls/PDF/rectal.pdf.
8.	Scott NA, Susnerwala S， Gollins S， et al. Preoperative neo-adjuvant therapy for curable rectal cancer-reaching a consensus 2008 [J]. Colorectal Dis, 2009； 11(3): 245-248.
9.	胡偉民, 鄧曉芳, 王進. 結直腸癌術前化療進展 [J]. 現代腫瘤醫學， 2007; 15(1): 132-134.
10.	Niederhuber JE. Neoadjuvant therapy [J]. Ann Surg， 1999; 229(3): 309-312.
11.	Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer [J]. N Engl J Med， 2004; 351(17): 1731-1740.
12.	Rullier E, Goffre B, Bonnel C, et al. Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum [J]. Ann Surg， 2001; 234(5): 633-640.
13.	Theodoropoulos G, Wise WE, Padmanabhan A, et al. T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival [J]. Dis Colon Rectum， 2002; 45(7): 895-903.
14.	Kim CJ, Yeatman TJ, Coppola D, et al. Local excision of T2 and T3 rectal cancers after downstaging chemoradiation [J]. Ann Surg， 2001; 234(3): 352-358.
15.	Pozzo C, Basso M, Cassano A, et al. Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients [J]. Ann Oncol， 2004; 15(6): 933-939.
16.	邱輝忠, 周皎琳. 直腸癌新輔助放化療 [J]. 癌癥進展， 2006; 4(1): 52-56.
17.	趙洪川. 直腸癌新輔助治療的研究進展 [J]. 世界華人消化雜志， 2008; 16(27): 3083-3085.
18.	Uzcudun AE, Batlle JF, Velasco JC, et al. Efficacy of preoperative radiation therapy for resectable rectal adenocarcinoma when combined with oral tegafur-uracil modulated with leucovorin: results from a phase Ⅱ study [J]. Dis Colon Rectum， 2002; 45(10): 1349-1358.
19.	Balani A, Turoldo A, Braini A, et al. Local excision for rectal cancer [J]. J Surg Oncol， 2000; 74(2): 158-162.
20.	Coco C, Magistrelli P, Granone P, et al. Conservative surgery for early cancer of the distal rectum [J]. Dis Colon Rectum， 1992; 35(2): 131-136.
21.	Wexner SD, Rotholtz NA. Surgeon influenced variables in re-sectional rectal cancer surgery [J]. Dis Colon Rectum， 2000; 43(11): 1606-1627.
22.	李立. 結直腸癌外科應用技術的規范與創新（八） [J]. 中國普外基礎與臨床雜志， 2007; 14(2): 216-221.
23.	Park C, Lee W, Han S, et al. Transanal local excision for preoperative concurrent chemoradiation therapy for distal rectal cancer in selected patients [J]. Surg Today， 2007; 37(12): 1068-1072.
24.	Chen CC, Leu SY, Liu MC, et al. Transanal local wide excision for rectal adenocarcinoma [J]. Hepatogastroenterology， 2005; 52(62): 460-463.
25.	Bujko K, Sopylo R, Kepka L. Local excision after radio (ch-emo) therapy for rectal cancer: is it safe? [J]. Clin Oncol (R Coll Radiol)， 2007; 19(9): 693-700.
26.	顧晉, 詹天成, 姚云峰. 結直腸癌的新輔助化療 [J]. 中國普外基礎與臨床雜志， 2007; 14(6): 628-629.
27.	Suárez J, Vera R, Balén E, et al. Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease-free survival after preoperative radiochemotherapy for advanced rectal cancer [J]. Colorectal Dis， 2008; 10(6): 563-568.
28.	Nair RM, Siegel EM, Chen DT, et al. Long-term results of transanal excision after neoadjuvant chemoradiation for T2 and T3 adenocarcinomas of the rectum [J]. J Gastrointest Surg， 2008; 12(10): 1797-1805.
29.	Ruo L, Guillem JG, Minsky BD, et al. Preoperative radiation with or without chemotherapy and full-thickness transanal excision for selected T2 and T3 distal rectal cancers [J]. Int J Colorectal Dis， 2002; 17(1): 54-58.
30.	Schell SR, Zlotecki RA, Mendenhall WM, et al. Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy [J]. J Am Coll Surg， 2002; 194(5): 584-590.
31.	Bonnen M, Crane C, Vauthey JN, et al. Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients [J]. Int J Radiat Oncol Biol Phys， 2004; 60(4): 1098-1105.
32.	Habr-Gama A, Perez RO, Proscurshim I, et al. Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: does delayed surgery have an impact on outcome? [J]. Int J Radiat Oncol Biol Phys， 2008; 71(4): 1181-1188.
33.	Kalady MF, de Campos-Lobato LF, Stocchi L, et al. Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer [J]. Ann Surg， 2009; 250(4): 582-589.
34.	Baxter NN, Morris AM, Rothenberger DA, et al. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis [J]. Int J Radiat Oncol Biol Phys， 2005; 61(2): 426-431.
35.	Lim JF, Tjandra JJ, Hiscock R, et al. Preoperative chemoradiation for rectal cancer causes prolonged pudendal nerve terminal motor latency [J]. Dis Colon Rectum， 2006; 49(1): 12-19.
36.	Bleday R, Breen E, Jessup JM, et al. Prospective evaluation of local excision for small rectal cancers [J]. Dis Colon Rectum， 1997; 40(4): 388-392.
37.	Rosenthal SA, Yeung RS, Weese JL, et al. Conservative management of extensive low-lying rectal carcinomas with transanal local excision and combined preoperative and postoperative radiation therapy. A report of a phase Ⅰ-Ⅱ trial [J]. Cancer， 1992; 69(2): 335-341.
38.	Fortunato L, Ahmad NR, Yeung RS, et al. Long-term follow-up of local excision and radiation therapy for invasive rectal cancer [J]. Dis Colon Rectum， 1995; 38(11): 1193-1199.
39.	Paty PB, Nash GM, Baron P, et al. Long-term results of local excision for rectal cancer [J]. Ann Surg， 2002; 236(4): 522-529.
40.	Biggers OR, Beart RW Jr, Ilstrup DM. Local excision of rectal cancer [J]. Dis Colon Rectum， 1986; 29(6): 374-377.
41.	Killingback M. Local excision of carcinoma of the rectum: indications [J]. World J Surg， 1992; 16(3): 437-446.
42.	Graham RA, Hackford AW, Wazer DE. Local excision of rectal carcinoma: a safe alternative for more advanced tumors? [J]. J Surg Oncol， 1999; 70(4): 235-238.

1. 　Anscher MS, Robertson CN, Prosnitz R. Adjuvant radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate: ten-year update [J]. Int J Radiat Oncol Biol Phys， 1995; 33(1): 37-43.
2. 　Crane CH, Das P. Potential benefits of integration of therapies with chemoradiation in rectal cancer [J]. Gastrointest Cancer Res， 2007; 1(4 Suppl 2): S73-S80.
3. 　 Sengupta S, Tjandra JJ. Local excision of rectal cancer: what is the evidence? [J]. Dis Colon Rectum， 2001; 44(9): 1345-1361.
4. 　Otmezguine Y, Grimard L, Calitchi E, et al. A new combined approach in the conservative management of rectal cancer [J]. Int J Radiat Oncol Biol Phys， 1989; 17(3): 539-545.
5. 　Nastro P, Beral D, Hartley J, et al. Local excision of rectal cancer: review of literature [J]. Dig Surg， 2005; 22(1-2): 6-15.
6. 　Borschitz T, Wachtlin D, Mhler M, et al. Neoadjuvant che-moradiation and local excision for T2-3 rectal cancer [J]. Ann Surg Oncol， 2008; 15(3): 712-720.
7. 　National Comprehensive Cancer Network. NCCA Clinical pr-actice guidelines in oncology-rectal cancer, V.4.2008, http://www.nccn.org/professionals/physician_gls/PDF/rectal.pdf.
8. 　Scott NA, Susnerwala S， Gollins S， et al. Preoperative neo-adjuvant therapy for curable rectal cancer-reaching a consensus 2008 [J]. Colorectal Dis, 2009； 11(3): 245-248.
9. 　胡偉民, 鄧曉芳, 王進. 結直腸癌術前化療進展 [J]. 現代腫瘤醫學， 2007; 15(1): 132-134.
10. 　Niederhuber JE. Neoadjuvant therapy [J]. Ann Surg， 1999; 229(3): 309-312.
11. 　Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer [J]. N Engl J Med， 2004; 351(17): 1731-1740.
12. 　Rullier E, Goffre B, Bonnel C, et al. Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum [J]. Ann Surg， 2001; 234(5): 633-640.
13. 　Theodoropoulos G, Wise WE, Padmanabhan A, et al. T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival [J]. Dis Colon Rectum， 2002; 45(7): 895-903.
14. 　Kim CJ, Yeatman TJ, Coppola D, et al. Local excision of T2 and T3 rectal cancers after downstaging chemoradiation [J]. Ann Surg， 2001; 234(3): 352-358.
15. 　Pozzo C, Basso M, Cassano A, et al. Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients [J]. Ann Oncol， 2004; 15(6): 933-939.
16. 　邱輝忠, 周皎琳. 直腸癌新輔助放化療 [J]. 癌癥進展， 2006; 4(1): 52-56.
17. 　趙洪川. 直腸癌新輔助治療的研究進展 [J]. 世界華人消化雜志， 2008; 16(27): 3083-3085.
18. 　Uzcudun AE, Batlle JF, Velasco JC, et al. Efficacy of preoperative radiation therapy for resectable rectal adenocarcinoma when combined with oral tegafur-uracil modulated with leucovorin: results from a phase Ⅱ study [J]. Dis Colon Rectum， 2002; 45(10): 1349-1358.
19. 　Balani A, Turoldo A, Braini A, et al. Local excision for rectal cancer [J]. J Surg Oncol， 2000; 74(2): 158-162.
20. 　Coco C, Magistrelli P, Granone P, et al. Conservative surgery for early cancer of the distal rectum [J]. Dis Colon Rectum， 1992; 35(2): 131-136.
21. 　Wexner SD, Rotholtz NA. Surgeon influenced variables in re-sectional rectal cancer surgery [J]. Dis Colon Rectum， 2000; 43(11): 1606-1627.
22. 　李立. 結直腸癌外科應用技術的規范與創新（八） [J]. 中國普外基礎與臨床雜志， 2007; 14(2): 216-221.
23. 　Park C, Lee W, Han S, et al. Transanal local excision for preoperative concurrent chemoradiation therapy for distal rectal cancer in selected patients [J]. Surg Today， 2007; 37(12): 1068-1072.
24. 　Chen CC, Leu SY, Liu MC, et al. Transanal local wide excision for rectal adenocarcinoma [J]. Hepatogastroenterology， 2005; 52(62): 460-463.
25. 　Bujko K, Sopylo R, Kepka L. Local excision after radio (ch-emo) therapy for rectal cancer: is it safe? [J]. Clin Oncol (R Coll Radiol)， 2007; 19(9): 693-700.
26. 　顧晉, 詹天成, 姚云峰. 結直腸癌的新輔助化療 [J]. 中國普外基礎與臨床雜志， 2007; 14(6): 628-629.
27. 　Suárez J, Vera R, Balén E, et al. Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease-free survival after preoperative radiochemotherapy for advanced rectal cancer [J]. Colorectal Dis， 2008; 10(6): 563-568.
28. 　Nair RM, Siegel EM, Chen DT, et al. Long-term results of transanal excision after neoadjuvant chemoradiation for T2 and T3 adenocarcinomas of the rectum [J]. J Gastrointest Surg， 2008; 12(10): 1797-1805.
29. 　Ruo L, Guillem JG, Minsky BD, et al. Preoperative radiation with or without chemotherapy and full-thickness transanal excision for selected T2 and T3 distal rectal cancers [J]. Int J Colorectal Dis， 2002; 17(1): 54-58.
30. 　Schell SR, Zlotecki RA, Mendenhall WM, et al. Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy [J]. J Am Coll Surg， 2002; 194(5): 584-590.
31. 　Bonnen M, Crane C, Vauthey JN, et al. Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients [J]. Int J Radiat Oncol Biol Phys， 2004; 60(4): 1098-1105.
32. 　Habr-Gama A, Perez RO, Proscurshim I, et al. Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: does delayed surgery have an impact on outcome? [J]. Int J Radiat Oncol Biol Phys， 2008; 71(4): 1181-1188.
33. 　Kalady MF, de Campos-Lobato LF, Stocchi L, et al. Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer [J]. Ann Surg， 2009; 250(4): 582-589.
34. 　Baxter NN, Morris AM, Rothenberger DA, et al. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis [J]. Int J Radiat Oncol Biol Phys， 2005; 61(2): 426-431.
35. 　Lim JF, Tjandra JJ, Hiscock R, et al. Preoperative chemoradiation for rectal cancer causes prolonged pudendal nerve terminal motor latency [J]. Dis Colon Rectum， 2006; 49(1): 12-19.
36. 　Bleday R, Breen E, Jessup JM, et al. Prospective evaluation of local excision for small rectal cancers [J]. Dis Colon Rectum， 1997; 40(4): 388-392.
37. 　Rosenthal SA, Yeung RS, Weese JL, et al. Conservative management of extensive low-lying rectal carcinomas with transanal local excision and combined preoperative and postoperative radiation therapy. A report of a phase Ⅰ-Ⅱ trial [J]. Cancer， 1992; 69(2): 335-341.
38. 　Fortunato L, Ahmad NR, Yeung RS, et al. Long-term follow-up of local excision and radiation therapy for invasive rectal cancer [J]. Dis Colon Rectum， 1995; 38(11): 1193-1199.
39. 　Paty PB, Nash GM, Baron P, et al. Long-term results of local excision for rectal cancer [J]. Ann Surg， 2002; 236(4): 522-529.
40. 　Biggers OR, Beart RW Jr, Ilstrup DM. Local excision of rectal cancer [J]. Dis Colon Rectum， 1986; 29(6): 374-377.
41. 　Killingback M. Local excision of carcinoma of the rectum: indications [J]. World J Surg， 1992; 16(3): 437-446.
42. 　Graham RA, Hackford AW, Wazer DE. Local excision of rectal carcinoma: a safe alternative for more advanced tumors? [J]. J Surg Oncol， 1999; 70(4): 235-238.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Advances of Neoadjuvant Therapy Combined with Transanal Resection in Stage T 2-3 Rectal Cancer

Abstract Full text Figures/Tables Video References Cited by

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