Are we doing too much?: local excision before radical surgery in early rectal cancer

Park, Sun Min; Kye, Bong-Hyeon; Kim, Min Ki; Jalloun, Heba Essam; Cho, Hyeon-Min; Lee, In Kyu

doi:10.1007/s00384-018-2982-1

Cited by 6 publications

(6 citation statements)

References 24 publications

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“… 26 A discrepancy in the preoperative and postoperative histological diagnoses is not uncommon. As a result of this inconsistency, some low-risk early rectal cancers may get operated with radical resections 27 and vice versa. Postoperative pathological stage and a comparison with the preoperative stage were only reported in one of the trials included in this meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

A Meta-analysis of Transanal Endoscopic Microsurgery versus Total Mesorectal Excision in the Treatment of Rectal Cancer

et al. 2021

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Background Transanal endoscopic microsurgery (TEMS) has been suggested as an alternative to total mesorectal excision (TME) in the treatment of early rectal cancers. The extended role of TEMS for higher stage rectal cancers after neoadjuvant therapy is also experimented. The aim of this meta-analysis was to compare the oncological outcomes and report on the evidence-based clinical supremacy of either technique. Methods Medline, Embase, and Cochrane databases were searched for the randomized controlled trials comparing the oncological and perioperative outcomes of TEMS and a radical TME. A local recurrence and postoperative complications were analyzed as primary end points. Intraoperative blood loss, operation time, and duration of hospital stay were compared as secondary end points. Results There was no statistical difference in the local recurrence or postoperative complications with a risk ratio of 1.898 and 0.753 and p-values of 0.296 and 0.306, respectively, for TEMS and TME. A marked statistical significance in favor of TEMS was observed for secondary end points. There was standard difference in means of −4.697, −6.940, and −5.685 with p-values of 0.001, 0.005, and 0.001 for blood loss, operation time, and hospital stay, respectively. Conclusion TEMS procedure is a viable alternative to TME in the treatment of early rectal cancers. An extended role of TEMS after neoadjuvant therapy may also be offered to a selected group of patients. TME surgery remains the standard of care in more advanced rectal cancers.

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Section: Discussionmentioning

confidence: 99%

A Meta-analysis of Transanal Endoscopic Microsurgery versus Total Mesorectal Excision in the Treatment of Rectal Cancer

et al. 2021

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“…Our findings suggest that, in selected patients, long-term oncological outcomes after endoscopic excision of the polyp by EMR or ESD are no different to current clinical practice in a centre where all three options are available at expert level and describes the dilemmas encountered at MDT. Several previous studies have examined oncological outcomes after local excision and radical surgery [3,[11][12][13]15]. However, most of these studies have included both colonic and rectal cancer making it difficult to draw conclusions about rectal cancer specifically [13].…”

Section: Discussionmentioning

confidence: 99%

“…Several previous studies have examined oncological outcomes after local excision and radical surgery [ 3 , 11 – 13 , 15 ]. However, most of these studies have included both colonic and rectal cancer making it difficult to draw conclusions about rectal cancer specifically [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, most of these studies have included both colonic and rectal cancer making it difficult to draw conclusions about rectal cancer specifically [ 13 ]. Others have investigated outcomes across all stages of cancer where local excision may not be sufficient to ensure complete removal of the tumour [ 3 ]. Reports of TEM/TAMIS surgery often include different histological types of cancer aside from adenocarcinoma or report other non-oncological outcomes making it difficult to draw conclusions about cancer-specific survival in these patients [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although this approach has considerably reduced local recurrence and improved survival, it is associated with significant risk of morbidity including sexual, urinary or bowel dysfunction [ 1 , 2 ]. Over the last few years, there has been increasing interest in developing organ-preserving approaches which would not subject patients to these risks [ 1 , 3 – 5 ].…”

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Oncological outcome after local treatment for early stage rectal cancer

et al. 2021

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Background Treatment of early rectal cancer is evolving towards organ-preserving therapy which includes endoscopic resection and transanal approaches. We aimed to explore the role of local treatments such as endoscopic polypectomy (Endoscopic Mucosal Resection (EMR) or Endoscopic submucosal dissection (ESD)) and transanal endoscopic microsurgery/ transanal minimal invasive surgery (TEM/TAMIS) in patients who had early rectal cancer. We considered these outcomes alongside conventional major surgery using total mesorectal excision (TME) for early stage disease. Methods All patients identified at MDT with early stage rectal cancer at our institution between 2010 and 2019 were included. Long-term outcomes in terms of local recurrence, survival and procedure-specific morbidity were analysed. Results In total, 536 patients with rectal cancer were identified, of which 112 were included based on their pre-operative identification at the MDT on the basis that they had node-negative early rectal cancer. Among these, 30 patients (27%) had the lesion excised by flexible endoscopic polypectomy techniques (EMR/ESD), 67 (60%) underwent TEM/TAMIS and 15 (13%) had major surgery. There were no differences in patient demographics between the three groups except for TEM/TAMIS patients being more likely to be referred from another hospital (p < 0.001) and they were less active (WHO performance status p = 0.04). There were no significant differences in overall survival rates and cancer-specific survival between the three treatment groups. The 5-year overall survival rate for endoscopic polypectomy, TEM/TAMIS or major resection was 96% versus 90% and 88%, respectively (p = 0.89). The 5- year cancer-specific survival rate was 96%, versus 96% and 100%, respectively (p = 0.74). Conclusion Endoscopic polypectomy by EMR/ESD is an appropriate local treatment for early stage rectal cancer in selected patients. It is possible to achieve good oncological outcomes with a polypectomy similar to TEM/TAMIS and major surgery; however, a multidisciplinary approach is necessary enabling close surveillance and the use of adjuvant radiotherapy.

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Local resection versus radical resection for early-stage rectal cancer: a systematic review and meta-analysis

Tan

et al. 2022

Int J Colorectal Dis

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Are we doing too much?: local excision before radical surgery in early rectal cancer

Cited by 6 publications

References 24 publications

A Meta-analysis of Transanal Endoscopic Microsurgery versus Total Mesorectal Excision in the Treatment of Rectal Cancer

A Meta-analysis of Transanal Endoscopic Microsurgery versus Total Mesorectal Excision in the Treatment of Rectal Cancer

Oncological outcome after local treatment for early stage rectal cancer

Local resection versus radical resection for early-stage rectal cancer: a systematic review and meta-analysis

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