Local Excision ± Chemoradiotherapy vs. Total Mesorectal Excision for Early Rectal Cancer: Case-Matched Analysis of Long-Term Results

Abstract

Background: Our aim was to compare the bowel function and oncologic outcomes following these two treatment modalities.Materials and methods: This was a single-center study with 67 patients included between 2009 and 2018. A total of 32 patients underwent total mesorectal excision (TME) group and 35 transanal local excisions (LE) ± chemoradiation. We performed a case-matched analysis: we matched the patients by age, cancer stage, and comorbidities. Duration of operation, postoperative complications, length of hospital stay, and long-term functional and oncological outcomes were compared. We calculated oncological outcomes using Kaplan–Meier Cox diagrams. In addition, we used a low anterior resection syndrome (LARS) score for the bowel function assessment.Results: Mean operation time in the LE group was 58.8 ± 45 min compared with the TME group that was 121.1 ± 42 min (p = 0.032). Complications were seen in 5.7% in LE group and 15.62% in TME group (p = 0.043). ~85.2% of the patients had no LARS in LE group compared with 54.5% in TME group (p = 0.018). Minor LARS was 7.4% in LE group compared with 31.8% in TME group (p = 0.018); major LARS was 7.4 and 13.7%, respectively (p = 0.474). Hospital stay was 2.77 days in LE group compared with 9.21 days in TME group (p = 0.036). The overall survival was 68.78 months in LE group compared with 74.81 months in TME group (p = 0.964).Conclusion: Our results of a small sample size showed that local excision ± chemoradiation is a rather safe method for early rectal cancer compared with gold standard treatment. In addition, better bowel function is preserved with less postoperative complications and shorter hospital stays.

Prognosis of Patients Over 60 Years Old With Early Rectal Cancer Undergoing Transanal Endoscopic Microsurgery – A Single-Center Experience

“…In addition, this study found no statistically significant differences in recurrent metastases and overall survival with or without adjuvant therapy after TEM. These findings are similar to the results of a recent study, concluding that survival after transanal local excision with or without chemoradiotherapy is comparable to that of TME, while TEM allows better bowel function and postoperative quality of life ( 54 ).…”

Is local excision with chemoradiotherapy the optimal treatment for early stage rectal cancer patients？a population-based study

“…Radical surgery carries a 2-3% risk of perioperative mortality and a 20-30% complication rate, including the need for permanent colostomy [41]. To mitigate these potential problems, local excision with adjuvant chemoradiotherapy have been demonstrated as an alternative to radical surgery in early stage rectal cancer patients [42,43]. Although NCCN guideline suggested transabdominal resection for T2 stage rectal cancer patients, local excision with chemoradiotherapy had been demonstrated to be a feasible alternative to radical surgery [13,44,45].…”

Surgeons’ choice for rectal cancer treatment if they were a patient

“…These include surgical options such as local excision techniques or radical surgery 1 , 2 . Patients with early rectal cancer without poor prognostic features may be offered local excision with or without adjuvant chemoradiotherapy 3 .…”