Authors: John H Marks E B Valsdottir A DeNittis S S Yarandi D A Newman I Nweze M Mohiuddin G J Marks
Publish Date: 2009/03/05
Volume: 23, Issue: 5, Pages: 1081-1087
Abstract
Neoadjuvant therapy for rectal cancer has led to improved tumor downstaging and higher complete pathologic response rates At the same time the introduction of transanal endoscopic microsurgery TEM technique has renewed interest in local excision of rectal cancer There has been concern that radiation may make the more radical local excision with TEM unsuitable Our study compared morbidity rates and wound complication rates for patients undergoing TEM and local excision with and without neoadjuvant radiation to determine whether this could be accomplished safelyData for all patients undergoing TEM are prospectively entered into a database This database was queried for patients with rectal cancer undergoing TEM from November 1997 to June 2007 Of 64 patients identified 2 were excluded because of previous radiation to the pelvisThe study enrolled 62 patients with a final pathologic diagnosis of rectal cancer 43 treated using neoadjuvant therapy with radiation XRT and 19 patients treated with TEM alone The patients in the XRT group were 67 years of age range 29–86 years and included 13 women The patients in the nonXRT group were 66 years of age range 40–89 years and included 8 women Neither group had any mortalities The overall morbidity rate was 33 for the XRT group and 53 for the nonXRT group and this difference was statistically significant p 005 The wound complication rates were 256 for the XRT group 11 patients and 0 for the nonXRT group p = 0015 Nine patients in the XRT group 82 had minor wound separations and two patients 18 had major wound separation Ten patients with wound separations were treated as outpatients and administered longterm oral antibiotics One patient required additional surgery diverting stomaNot unexpectedly the wound complication rate was higher in the XRT group However 82 of those wounds were minor and 91 were treated without any additional surgery or intervention Although a significant concern wound complications do not prohibit TEM treatment after neoadjuvant treatment
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