Preoperative Chemoradiotherapy and Transanal Endoscopic Microsurgery Versus Total Mesorectal Excision in T2-T3s N0, M0 Rectal Cancer

Conditions

Rectal Cancer

Keywords

Preoperative chemoradiotherapy, Transanal endoscopic microsurgery, Rectal Cancer, T2-T3s-N0

Brief summary

The standard treatment of rectal adenocarcinoma is total mesorectal excision (TME). The technique involves a low anterior rectal or colo-anal resection, very often associated with a protective stoma or abdominal-perineal resection with permanent colostomy. Transanal endoscopic microsurgery (TEM) allows access to tumors up to 20 cm from the anal margin, with minimal postoperative morbidity and mortality. Recent studies of T1 rectal adenocarcinomas consider TEM to be the technique of choice. However the treatment of T2 rectal cancers remains controversial. Chemotherapy and radiotherapy (CT/RT) has achieved a concomitant reduction in local recurrence and an increase in survival. Hypothesis: Patients with rectal adenocarcinoma less than 10 cm from the anal margin and up to 4 cm in size, staged after endorectal ultrasound and MRI as T2 or superficial T3 N0-M0-N0-M0, who underwent surgery after preoperative local chemoradiotherapy (TEM), achieve effective results in terms of local recurrence similar to radical surgery (TME). OBJECTIVES: Primary: To compare the results of local recurrence at 2 years in patients treated with preoperative chemoradiotherapy and TEM and in patients treated with conventional radical surgery (TME). Secondary: To analyse the 3-year survival results in patients treated with CT/RT. Methodology: Multicenter clinical trial in a calculated sample of 173 patients.

Serra-Aracil X, Pericay C, Cidoncha A, Badia-Closa J, Golda T, Kreisler E, Hernández P, Targarona E, Borda-Arrizabalaga N, Reina A, Delgado S, Espín-Bassany E, Caro-Tarrago A, Gallego-Plazas J, Pascual M, Álvarez-Laso C, Guadalajara-Labajo H, Otero A, Biondo S, TAUTEM Collaborative Group.

2025-07-015 citations

10.1001/jamasurg.2025.1398

Short-term outcomes of chemoradiotherapy and local excision versus total mesorectal excision in T2-T3ab,N0,M0 rectal cancer: a multicentre randomised, controlled, phase III trial (the TAU-TEM study).

Serra-Aracil X, Pericay C, Badia-Closa J, Golda T, Biondo S, Hernández P, Targarona E, Borda-Arrizabalaga N, Reina A, Delgado S, Vallribera F, Caro A, Gallego-Plazas J, Pascual M, Álvarez-Laso C, Guadalajara-Labajo HG, Mora-Lopez L.

2022-10-0841 citations

10.1016/j.annonc.2022.09.160

Noninferiority multicenter prospective randomized controlled study of rectal cancer T2–T3s (superficial) N0, M0 (T2T3sN0M0) undergoing neoadjuvant treatment and local excision (TEM) versus total mesorectal excision (TME): Preoperative, surgical, and pathological outcomes—The TAUTEM-study.

Xavier Serra‐Aracil, Carles Pericay, Jesus Badía-Closa, Thomas Golda, Sebastiano Biondo et al. (18 authors)

Journal of Clinical Oncology2022-06-014 citations

10.1200/jco.2022.40.16_suppl.3501

Non-inferiority multicenter prospective randomized controlled study of rectal cancer T2-T3s (superficial) N0, M0 undergoing neoadjuvant treatment and local excision (TEM) vs total mesorectal excision (TME).

Serra-Aracil X, Pericay C, Golda T, Mora L, Targarona E, Delgado S, Reina A, Vallribera F, Enriquez-Navascues JM, Serra-Pla S, Garcia-Pacheco JC, TAU-TEM study group.

2017-12-1221 citations

10.1007/s00384-017-2942-1

Interventions

PROCEDURETransanal Endoscopic Microsurgery

6-8 weeks after Chemoradiotherapy

DRUGCapecitabine (Xeloda)

Capecitabine 825 mg/m2 every 12 hours orally on days of radiotherapy

RADIATION50.4 Gy

Radiotherapy was administered in daily fractions of 1.8 Gy 5 days a week according to standard schema. The total dose is 45 Gy plus a boost of 5.4 Gy to the tumor area

PROCEDURETotal Mesorectal Excision

Standard surgical treatment of T2 , T3s, N0, M0 rectal cancer. Early after diagnosis

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

1. Rectal adenocarcinomas located 10 cm or less from the inferior anal verge measured using a rigid rectoscope at the time of the EUS. 2. Preoperative staging by EUS and pelvic MRI of T2 or T3 superficial, N0. In case of disparity, the higher staging is considered as the definitive diagnosis. 3. Tumours equal to or less than 4 cm of diameter maximum measured using colonoscopy, EUS or MRI. We use the highest score on both scores. 4. ASA score III or less. 5. Absence of distance metastasis as shown on abdominal CT.

Exclusion criteria

1. Preoperative staging by EUS or pelvic MRI of T1, deep T3, T4 or N1. 2. Presence of distance metastasis. 3. Synchrony with other colorectal adenocarcinomas. 4. Undifferentiated rectal adenocarcinomas or with presence of poor prognosis factors in preoperative biopsy. 5. Patients with intolerance of preoperative chemotherapy or radiotherapy. 6. Refusal to sign informed consent to enter the study.

Design outcomes

Primary

Measure	Time frame	Description
Local recurrence	2 years	To analyse the results for local recurrence after 2 years in patients treated with preoperative chemoradiotherapy and TEO, with patients treated with conventional radical surgery (TME).

Countries

Spain

Outcome results

None listed