Brachytherapy and Local Excision for Sphincter Preservation in T1 and T2 Rectal Cancer

A systematic review of local excision combined with chemoradiotherapy for early rectal cancer

“…Studies were grouped into four categories according to excision technique and timing of chemoradiotherapy (Table 1). There was one randomized controlled trial (RCT) that compared TEM and TME following a uniform neoadjuvant regimen [7], two studies of adjuvant radiotherapy after TEM [8,9], seven studies of LE followed by adjuvant chemoradiotherapy [10][11][12][13][14][15][16] and one study of either TLE or TEM followed by postoperative radiotherapy [17].…”

“…With a median range of follow-up of 30.5-115.2 months across all studies, median OS, DSS and DFS were 75% (range 66-80.6%) [7,11,12,16], 89% (75-93.3%) [7,8,11,12,16] and 74% (64-85.2%) [12,13,16], respectively. Median local, distant and overall recurrence rates were 10% (4.8-25%) [7][8][9][10][11][12][13][14][15][16][17], 4.7% (4-11.8%) [7-10,12,16,17] and 13.1% (10.7-23.5%) [7][8][9][10]12,16,17], respectively. The median rate of local failure was 10% (4.8-25%) [7][8][9][10][11][12][13][14][15][16][17].…”

“…Median local, distant and overall recurrence rates were 10% (4.8-25%) [7][8][9][10][11][12][13][14][15][16][17], 4.7% (4-11.8%) [7-10,12,16,17] and 13.1% (10.7-23.5%) [7][8][9][10]12,16,17], respectively. The median rate of local failure was 10% (4.8-25%) [7][8][9][10][11][12][13][14][15][16][17]. The median rate of salvage surgery, expressed as a percentage of patients with local recurrence undergoing surgical re-resection, was 100% (range 62.5-100%) [8][9][10][11]14,16,17].…”

“…The median rate of local failure was 10% (4.8-25%) [7][8][9][10][11][12][13][14][15][16][17]. The median rate of salvage surgery, expressed as a percentage of patients with local recurrence undergoing surgical re-resection, was 100% (range 62.5-100%) [8][9][10][11]14,16,17].…”

Oncological outcomes of transanal local excision for high risk T1rectal cancers

“…However, the main disadvantages of these radical procedures include significant mortality and morbidity, as well as the necessity of permanent colostomy that may not be warranted for early rectal cancers which may be treated with local excision [5,6] . With less intraoperative blood loss [7] , shorter length of hospital stay [8,9] , lower postoperative mortality and morbidity [10,11] , excellent maintenance of function [12,13] and avoidance of permanent colostomy [14,15] , the benefits of local excision compared to radical surgery are significant. However, local excision carries the unavoidable risk of leaving untreated potential disease in the mesorectum and cannot provide adequate nodal staging because mesorectal lymph nodes are not removed and are therefore not pathologically assessed.…”