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

M. Verseveld, E. J. de Graaf, C. Verhoef, E. van Meerten, C.J. Punt, I.H. de Hingh, I.D. Nagtegaal, J.J. Nuyttens, C.A. Marijnen, Geerard Beets, J.H. de Wilt

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Abstract

BACKGROUND: This prospective multicentre study was performed to quantify number of patients with minimal residual disease (ypT0-1) after chemoradiotherapy and transanal endoscopic microsurgery (TEM) for rectal METHODS: Patients with clinically staged T1-3 N0 distal rectal cancer treated with long-course chemoradiotherapy. Clinical response was weeks later and TEM performed. Total mesorectal excision was advocated patients with residual disease (ypT2 or more). RESULTS: The clinical cT1 N0 in ten patients, cT2 N0 in 29 and cT3 N0 in 16 patients. Chemoradiotherapy-related complications of at least grade 3 occurred in patients, with two deaths from toxicity, and two patients did not have major surgery. Among 47 patients who had TEM, ypT0-1 disease was found ypT0 N1 in one, ypT2 in 15 and ypT3 in one. Local recurrence developed of the nine patients with ypT2 tumours who declined further surgery. Postoperative complications grade I-IIIb occurred in 13 of 47 patients and in five of 12 after (completion) surgery. After a median follow-up months, four local recurrences had developed overall, three in patients and one with ypT1 disease. CONCLUSION: TEM after chemoradiotherapy preservation in one-half of the patients with rectal cancer.
Original languageEnglish
Pages (from-to)853-860
Number of pages8
JournalBritish Journal of Surgery
Volume102
Issue number7
DOIs
Publication statusPublished - Jun 2015

Keywords

  • TOTAL MESORECTAL EXCISION
  • DOSE PREOPERATIVE RADIATION
  • THICKNESS LOCAL EXCISION
  • II CLINICAL-TRIAL
  • NEOADJUVANT CHEMORADIATION
  • RADICAL RESECTION
  • RADIOTHERAPY
  • CHEMORADIOTHERAPY
  • SURGERY
  • MULTICENTER

Cite this

Verseveld, M., de Graaf, E. J., Verhoef, C., van Meerten, E., Punt, C. J., de Hingh, I. H., Nagtegaal, I. D., Nuyttens, J. J., Marijnen, C. A., Beets, G., & de Wilt, J. H. (2015). Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery (CARTS study). British Journal of Surgery, 102(7), 853-860. https://doi.org/10.1002/bjs.9809