T3 and transanal excision - anyone whom had this and can report in?

dschreffler

Greetings, came across a few studies on this and am curious on those whom had T3 rectal and transanal excision to remove, how long ago it was and what your experience was in terms of reoccurrence, etc?

These studies have a small sample size, so I know this is not standard of care as generally APR or LAR the recommendation.

2008: Long-Term Results of Transanal Excision After Neoadjuvant Chemoradiation for T2 and T3 Adenocarcinomas of the Rectum
26 men and 18 women. Overall 5-year survival rates for T2/T3N0 and T2/T3N1 patients were 84% and 81%, respectively.

2004: Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients
Actuarial overall survival at 5 years was 86% in the local-excision group compared with 81% among mesorectal-excision patients (p = NS), and 85% in patients with a complete clinical response to chemoradiation followed by mesorectal excision by APR or LAR (p = NS).
26 patients.
In an experience stimulated by patient refusal of APR, highly selected patients who responded well to conventional external-beam radiotherapy (CXRT) were selected to undergo local excision. Most of these patients had pathologic complete response. Local control and survival rates are comparable to those achieved with chemoradiation followed by mesorectal excision. This strategy should be prospectively studied in a group of patients with low rectal cancer who have no clinical evidence of tumor after chemoradiation.

2002: Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy
11 patients
CONCLUSIONS: In patients 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.

imagineit2010

Good information
That sounds like a common sense approach. Only problem is the doctors don't like common sense they like money and this method of treatment would cost them big bucks. Can you imagine the revenue lost to hospitals and doctors if they did this for even half the patients who would otherwise get major surgery. Not to mention all the complication follow-ups after colostomies. I have read many reports on studies showing positive outcomes from other options but they don't want to hear about it. Patients NEED options from conventional medicine and doctors. I'm afraid too many times OUR best intrest is not THEIR best interest. That is why it's very frustrating dealing with conventional doctors. I presented my doctor with all kinds of study reports and statistics and asked many questions and his response was " look, you can research until you turn blue but you just need to start the treatment". He didn't have any answers that were not well rehearsed. Many times they act like "my way or the highway". Personaly, I took the highway.....
Good luck finding someone to listen to you suggeastions. If you do, let me know...
Chris

dasspears

Your experience?
Really, what's the question?

dasspears

Your experience?
Really, what's the question?

dschreffler

dasspears said:

Your experience?
Really, what's the question?

Sorry was not clear in
Sorry was not clear in asking.. the question is if you have been staged at T3 and treated by transanal, can you share your results, how long since surgery and any reoccurrence of the cancer, etc? Looking for outcome - did it work and any functional issues.

dschreffler

imagineit2010 said:

Good information
That sounds like a common sense approach. Only problem is the doctors don't like common sense they like money and this method of treatment would cost them big bucks. Can you imagine the revenue lost to hospitals and doctors if they did this for even half the patients who would otherwise get major surgery. Not to mention all the complication follow-ups after colostomies. I have read many reports on studies showing positive outcomes from other options but they don't want to hear about it. Patients NEED options from conventional medicine and doctors. I'm afraid too many times OUR best intrest is not THEIR best interest. That is why it's very frustrating dealing with conventional doctors. I presented my doctor with all kinds of study reports and statistics and asked many questions and his response was " look, you can research until you turn blue but you just need to start the treatment". He didn't have any answers that were not well rehearsed. Many times they act like "my way or the highway". Personaly, I took the highway.....
Good luck finding someone to listen to you suggeastions. If you do, let me know...
Chris

Actually it is my surgeon
Actually it is my surgeon whom is recommending TAE, and in my initial research I could not find evidence to support his recommendation.

I really have not come across that "my way or highway" attitude in my interactions with 3 surgeons/hospitals/oncologists. They did make their case for what they would recommend, and the other options and really said up to me. Only 1 recommended strongly the transanal and hence my initial apprehension of it. My oncologist was also lobbying for it given the excellent response I had to pre operative chemo/radiation.

Studies for T3/TAE are few and sample sizes small, so Dr's are, and should default to statistically proven standard of care. I less think it has to do with them making $ vs more on conservative approach to cure and maybe defensive medicine in the time of lawsuits.

imagineit2010

dschreffler said:

Actually it is my surgeon
Actually it is my surgeon whom is recommending TAE, and in my initial research I could not find evidence to support his recommendation.

I really have not come across that "my way or highway" attitude in my interactions with 3 surgeons/hospitals/oncologists. They did make their case for what they would recommend, and the other options and really said up to me. Only 1 recommended strongly the transanal and hence my initial apprehension of it. My oncologist was also lobbying for it given the excellent response I had to pre operative chemo/radiation.

Studies for T3/TAE are few and sample sizes small, so Dr's are, and should default to statistically proven standard of care. I less think it has to do with them making $ vs more on conservative approach to cure and maybe defensive medicine in the time of lawsuits.

Well allright, it sounds
Well allright, it sounds like you found a good one. (doctor) There are a couple old timers who had this done, they're not really on here much if at all anymore. Did you search on here? Just type in transanal and you can read a couple of their experiences. They mostly sound positive except for some "leakage" issues while healing. I'm assuming you were stage II T3. The Gastro Doc who first diagnosed me thought I would be treated like this but the surgeon and oncologist dissagreed. That wasn't even an option for them. The surgeon seemed too anxious to attempt a "hand sewn anastomosis" with only 1cm of clearance which didn't seem very realistic and it being a teaching hospital I got the feeling he was doing it for himself as much as for me. So I hesitated to proceed. Anyway, I would say it's better to start there if it really is an option compared to jumping right into a major permanent surgery. If it were offered to me I would definetly consider it.
Best of luck.

dschreffler

Follow up. I figured the
Follow up. I figured the board could use some good news.

My post surgery pathology/CEA, and today's rectal endoscopy show no signs of cancer following neoadjuctive chemo, and my June transanal excision.

I'm in round 4 of 12 post surgery Folfox (protocol for transanal) to ensure we keep the little bastards down and out.

Cheers.

AnneCan

dschreffler said:

Follow up. I figured the
Follow up. I figured the board could use some good news.

My post surgery pathology/CEA, and today's rectal endoscopy show no signs of cancer following neoadjuctive chemo, and my June transanal excision.

I'm in round 4 of 12 post surgery Folfox (protocol for transanal) to ensure we keep the little bastards down and out.

Cheers.

Fantastic!
Thanks for sharing. That's what we need to do; keep those little bastards down + out. Even printing the word "bastards" makes me feel good!

Kerry S

Yep, I had TAE in 4/08 type 3
Yep, I had TAE in 4/08 type 3. The problem was it had metastasized to a node near it and to my liver. Had chemo/rad to get the node. Then chemo embolization to get the liver cleared.

I was NED starting 1/09. Had recurrence in the rectum 8/10 of same type 3. Could not get this one with TAE. Now on the temp ileo bag after resection. Reconnection is going to be 11/10. I should be NED after this last slice & dice as it was the only thing that showed up on PET scan.

Kerry

462lt

dschreffler said:

Follow up. I figured the
Follow up. I figured the board could use some good news.

My post surgery pathology/CEA, and today's rectal endoscopy show no signs of cancer following neoadjuctive chemo, and my June transanal excision.

I'm in round 4 of 12 post surgery Folfox (protocol for transanal) to ensure we keep the little bastards down and out.

Cheers.

great news
Really glad things are going well. Don't second guess yourself sounds like you made the right decision. All I can think about now is if I had gone with the doctor in Savannah and was sitting here now with a bag and there was a hope that I didn't have to have one I would be PISSED! It dosen't seem from everything I have read much difference between reoccurance rate between APR and TAE in the right circumtancses.Maybe less then 4% I'll take that odds. Believe me I am not a polly anna either way can still come back I'll take my time bag free for as long as possible, and if it has already spread nothing will have changed that. Anyway glad you are doing well and am happy with my results. Laura

theresa8

dschreffler said:

Follow up. I figured the
Follow up. I figured the board could use some good news.

My post surgery pathology/CEA, and today's rectal endoscopy show no signs of cancer following neoadjuctive chemo, and my June transanal excision.

I'm in round 4 of 12 post surgery Folfox (protocol for transanal) to ensure we keep the little bastards down and out.

Cheers.

Same cancer for my hubby, T3N0M0
I've been reading all your posts since my husband had the same cancer and treatment that you have. He had a complete response to the pre-surgery chemo-radiation . He had an illeostomy for 7 months with the 12 rounds of post surgery Folfox. He had his reversal surgery 3 weeks ago on Monday and I can tell you that things are back to normal and he is as good as new.
We were expecting rough times in getting back to normal bowel movements since all of his rectum was removed but the colon which now acts as his rectum sure got the hang of this fast. I wish you the best and that 84% survival rate for his type of cancer sure boosted my spirits in the aftermath of this terrible year that has just ended.
Wishing you the best.
Theresa