Analysis on Safety and Efficacy of Local Excision vs Total Mesorectal Excision for T2N0M0 Mid-Low Rectal Cancer

Abstract

[Background] To investigate the clinical safety and efficacy of local excision with endovascular gastrointestinal anastomosis stapler (Endo-GIA) in the treatment of T2N0M0 mid-low rectal cancer patients. [Methods] 62 patients admitted with T2N0M0 mid-low rectal cancer in our hospital were collected from January 2015 to December 2018. According to the surgical methods,these patients were divided into local excision group (LE group) and total mesorectal excision group (TME group). 29 patients in the LE group underwent transanal LE with Endo-GIA. 33 patients in the TME group underwent conventional radical surgery according to the principle of TME, including 25 patients receiving Dixon,and 8 patients receiving Miles. Comparative analyses were performed on basic materials, intraoperative and postoperative indicators, and prognosis status between the two groups. [Results] There were no significant differences in BMI, gender, pathological types,tumor size,and tumor distance from the anal verge between LE group and TME group had.Only average age of LE group was higher than that of TME group because several older patients had strong sphincter-preserving willingness and could not tolerate radical surgeries.General characteristics of patients were comparable between the two groups.However, the two groups had significant differences in mean operation time, postoperative hospital stay, intraoperative bleeding volume, and the rate of postoperative complications. The local recurrence rate, mortality rate, overall survival, and 1-year/3-year disease-free survival had no statistical differences between the two groups. [Conclusion] LE combined with Endo-GIA can achieve the same clinical efficacy and safety as TME for patients with T2N0M0 mid-low rectal cancer. LE with Endo-GIA has obvious advantages of less trauma, fewer surgical complications, quicker recovery, and higher living quality over TME.