Abstract
Background: Our aim was to compare the bowel function and oncologic outcomes following these two treatment modalities.Materials and methods: This was a single-center study with 67 patients included between 2009 and 2018. A total of 32 patients underwent total mesorectal excision (TME) group and 35 transanal local excisions (LE) ± chemoradiation. We performed a case-matched analysis: we matched the patients by age, cancer stage, and comorbidities. Duration of operation, postoperative complications, length of hospital stay, and long-term functional and oncological outcomes were compared. We calculated oncological outcomes using Kaplan–Meier Cox diagrams. In addition, we used a low anterior resection syndrome (LARS) score for the bowel function assessment.Results: Mean operation time in the LE group was 58.8 ± 45 min compared with the TME group that was 121.1 ± 42 min (p = 0.032). Complications were seen in 5.7% in LE group and 15.62% in TME group (p = 0.043). ~85.2% of the patients had no LARS in LE group compared with 54.5% in TME group (p = 0.018). Minor LARS was 7.4% in LE group compared with 31.8% in TME group (p = 0.018); major LARS was 7.4 and 13.7%, respectively (p = 0.474). Hospital stay was 2.77 days in LE group compared with 9.21 days in TME group (p = 0.036). The overall survival was 68.78 months in LE group compared with 74.81 months in TME group (p = 0.964).Conclusion: Our results of a small sample size showed that local excision ± chemoradiation is a rather safe method for early rectal cancer compared with gold standard treatment. In addition, better bowel function is preserved with less postoperative complications and shorter hospital stays.
Highlights
Colorectal cancer is common cancer worldwide with rectal cancer accounting for approximately 30% of all colorectal malignancies [1]
Thanks to cancer screening programs, the proportion of rectal cancers diagnosed at an early stage are increasing in Western countries, which gives the capability of reducing the size of the operation and minimizing negative effects on low anterior resection with total mesorectal excision (TME) [6]
local excision (LE) plus chemoradiotherapy approach possibly decreases the risk of bowel dysfunction and gives acceptable local/distant recurrence rates by decontaminating the mesorectal lymph nodes and the excision bed
Summary
Colorectal cancer is common cancer worldwide with rectal cancer accounting for approximately 30% of all colorectal malignancies [1]. Over the last three decades, the gold standard treatment was total mesorectal excision (TME) with or without neoadjuvant chemoradiotherapy, which has shown significant improvements with respect to local disease control [2]. This treatment is associated with certain numbers of mortality (4%) and morbidity (from 6 to 35%) [3, 4]. LE plus chemoradiotherapy approach possibly decreases the risk of bowel dysfunction and gives acceptable local/distant recurrence rates by decontaminating the mesorectal lymph nodes and the excision bed. There is limited knowledge on the long-term functional and oncological results of TME vs LE ± chemoradiotherapy for early rectal cancer. Our aim was to compare the bowel function and oncologic outcomes following these two treatment modalities
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