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Abstract
BackgroundLocal excision (LE) is a feasible treatment approach for rectal cancers in stage pT1 and presents low pathological risk, whereas total mesorectal excision (TME) is a reasonable treatment for more advanced cancers. On the basis of the pathology findings, surgeons may suggest TME for patients receiving LE. This study compared the survival outcomes between LE with/without chemoradiation and TME in mid and low rectal cancer patients in stage pT1/pT2, with highly selective intermediate pathological risk.MethodsThis retrospective study included 134 patients who received TME and 39 patients who underwent LE for the treatment of intermediate risk (pT1 with poor differentiation, lymphovascular invasion, perineural invasion, relatively large tumor, or small-sized pT2 tumor) rectal cancer between 1998 and 2016.ResultsOverall survival (OS), disease-free survival (DFS), and cumulative recurrence rate (CRR) were similar between the LE (3-year DFS 92%) and TME (3-year DFS 91%) groups. Following subgrouping into an LE with adjuvant therapy group and a TME without adjuvant therapy group, the compared survival outcomes (OS, DFS, and CRR) were found not to be statistically different. The temporary and permanent ostomy rates were higher in the TME group than in the LE group (p < 0.001). Rates of early and late morbidity following surgery were higher in the TME group (p = 0.005), and LE had similar survival compared with TME.ConclusionFor patients who had mid and low rectal cancer in stage pT1/pT2 and intermediate pathological risk, LE with chemoradiation presents an alternative treatment option for selected patients.
Highlights
Local excision (LE) is a feasible treatment approach for rectal cancers in stage pT1 and presents low pathological risk, whereas total mesorectal excision (TME) is a reasonable treatment for more advanced cancers
Local excision (LE), including transanal excision, transanal polypectomy, and transanal endoscopic microsurgery, might be able to improve the quality of life (QoL) of patients by achieving similar oncological outcomes
Using the careful selection method adopted in the trial, our study aimed to demonstrate LE with concurrent chemoradiation (CCRT) as oncologically equivalent to TME for mid and low rectal cancer in stage pT1/pT2, with intermediate pathological risk
Summary
Local excision (LE) is a feasible treatment approach for rectal cancers in stage pT1 and presents low pathological risk, whereas total mesorectal excision (TME) is a reasonable treatment for more advanced cancers. This study compared the survival outcomes between LE with/without chemoradiation and TME in mid and low rectal cancer patients in stage pT1/pT2, with highly selective intermediate pathological risk. The treatment decision for patients with mid and low rectal cancer is crucial for considerations related to quality of life (QoL). Local excision (LE), including transanal excision, transanal polypectomy, and transanal endoscopic microsurgery, might be able to improve the QoL of patients by achieving similar oncological outcomes. The development of adjuvant concurrent chemoradiation (CCRT) has shown improvement in oncological outcomes, with more studies suggesting LE with adjuvant CCRT as an option for selected patients.
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