Early and late morbidity of local excision after chemoradiotherapy for rectal cancer

Abstract

Background Local excision (LE) after chemoradiotherapy is a new option in low rectal cancer, but morbidity has never been compared prospectively with total mesorectal excision (TME). Early and late morbidity were compared in patients treated either by LE or TME after neoadjuvant chemoradiotherapy for rectal cancer. Method This was a post-hoc analysis from a randomized trial. Patients with clinical T2/T3 low rectal cancer with good response to the chemoradiotherapy and having either LE, LE with eventual completion TME, or TME were considered. Early (1 month) and late (2 years) morbidities were compared between the three groups. Results There were no deaths following surgery in any of the three groups. Early surgical morbidity (20 per cent LE versus 36 per cent TME versus 43 per cent completion TME, P = 0.025) and late surgical morbidity (4 per cent versus 33 per cent versus 57 per cent, P < 0.001) were significantly lower in the LE group than in the TME or the completion TME group. of LE, was associated with the lowest rate of early (10 versus 18 versus 21 per cent, P = 0.217) and late medical morbidities (0 versus 7 versus 7 per cent, P = 0.154), although this did not represent a significant difference between the groups. The severity of overall morbidity was significantly lower at 2 years after LE compared with TME or completion TME (4 versus 28 versus 43 per cent grade 3–5, P < 0.001). Conclusion The rate of surgical complications after neoadjuvant chemoradiotherapy in the LE group was half that of TME group at 1 month and 10 times lower at 2 years. LE is a safe approach for organ preservation and should be considered as an alternative to watch-and-wait in complete clinical responders and to TME in subcomplete responders.

Current guidelines for the management of rectal cancer patients: a review of recent advances and strategies

“…The same idea is not applied to T2 lesions, where recurrence rates may achieve 26–47% in patients 23 . In those presenting an almost complete response after neoadjuvant treatment, endoanal local excision may also be recommended, despite wound complications in a rectum previously irradiated 24 .…”

Long-term efficacy of transanal local excision versus total mesorectal excision after neoadjuvant treatment for rectal cancer: A meta-analysis

“…TLE is a surgical technique that utilizes the natural cavity for operation, leading to smaller trauma. In comparison to TME, TLE is associated with a lower incidence of surgical complications and a better postoperative quality of life [16][17][18]. However, LR after TLE in rectal cancer patients is known to be high, even for those with early rectal cancer [19][20][21][22].…”

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

“…There is no denying that TME carries the risk of urogenital and anorectal dysfunctions, permanent stula after surgeries and poor quality of life (QoL) [3] . In recent years, characterized by the simple operation, small surgical injury, low complication rate, quick postoperative recovery, high QoL, and higher rate of sphincter preservation, local excision (LE) has been increasingly recognized [4] . Based on the trade-offs of risks and oncologic bene ts, LE may be a new option for earlystage rectal cancer and has been recommended by several versions of rectal cancer diagnosis and treatment guidelines.…”