BACKGROUND: Our institution has previously demonstrated a survival advantage conferred by preoperative neoadjuvant therapy for locally advanced @entity5 . We now report our results using transanal excision as definitive surgical therapy in a selected group of @entity1 who experienced significant downstaging of T3 @entity5 after neoadjuvant therapy. STUDY DESIGN: Seventy-four @entity1 diagnosed with locally advanced (T3) @entity5 were treated with neoadjuvant chemoradiotherapy. After neoadjuvant therapy, 11 (14.9%) @entity1 who had significant downstaging of their @entity5 were selected to undergo transanal excision of their residual @entity5 . Intraoperative cryostat evaluation was used to confirm negative margin status, and all @entity1 were subsequently followed with routine endoscopy, transrectal ultrasonography, and digital rectal examinations. RESULTS: @entity5 were located between 1 cm and 7 cm from the anal verge (mean 4.3 +/- 0.6 cm), and were located in lateral, anterior, and posterior positions. Mean followup was 55.2 +/- 8.9 months (median 47.9 months). Imaging studies using CT, MRI, transrectal ultrasonography, or combination demonstrated suspicious lymph nodes in three @entity1 . After neoadjuvant therapy, these lymph nodes were no longer demonstrated in two @entity1 . There were no local recurrences, nodal metastases, or operative mortalities. One @entity1 (9%) developed distant metastases (pulmonary nodules), and remains alive 30 months after transanal excision. One @entity1 (9%) experienced sphincter laxity, which was successfully repaired, and is now asymptomatic. One @entity1 (9%) developed postoperative urgency that resolved spontaneously. CONCLUSIONS: In @entity1 who have initial bulky (T3) lesions, and experience significant downstaging after neoadjuvant chemoradiotherapy, transanal excision appears to be a safe and effective treatment, preserving sphincter function and avoiding laparotomy.

Transanal excision of locally advanced XXXX downstaged using neoadjuvant chemoradiotherapy.

@entity5 :: ('MESH:D009369', 'Disease') :: ['Tumors', 'rectal cancers', 'tumors'] @entity1 :: ('9606', 'Species') :: ['patients', 'patient']
@entity5 :: (MESH:D009369,Disease) :: ['rectal cancers']
