For me not "very risky" as having researched options for 3 months, based on how my tumor responded to neoadjuctive chemorad, and the clear margins shown in pathology from the surgery.
TAE surgery alone is risky whether for T3 , T2 or even T1. But add in the following, and risks mitigated:
1) Post surgery chemo - I will have 9 sessions of FOLFOX starting 7/19. This is same chemo I would have received if they found positive nodes.
2) Do prescribed follow ups - scope/ultra sound every 3 months/CT every 6 months for 2 years. Already queued up for September.
The advantage is less complications (recovery time, bowel mgt.), and less surgeries (temp ileo, then takedown/reversal).
The LAR and pull through surgeries also had risk - anytime doing surgery you are at risk, but quality of life aspects compel folk to understand the risk vs rewards and then choose based on those facts. Take down/reversal surgeries do not prevent cancer reoccurrence. All patience could default to APR's, but they understand the risks to get to a possibly better quality of life - despite the risk due to additional surgeries and complications.
In my case, I decided to do the least amount of cutting to the body while still ensuring the cancer got removed.
As posted in prior thread: (viewtopic.php?f=1&t=11804&start=45
Neoadjuctive chemo/rad + TAE + more chemo
This approach was heavily favored by both my local surgeon and oncologist given my reponse to the chemo and radiation so far, as well as my youthful age of 45.
1) cancer removal - Onocological results in line with other options provided post surgery chemo and with proper surveillance (scope/ultra sound every 3 months for 2 years. CT every 6 months.)
2) quality of life - Expecting little impact on fecal control or impact to sexual/urinary function short term and more importantly long term.
3) Balance surgery and recovery time vs benefit of surgery. The least recovery time due to surgeries or any option.
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).
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
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.