Survival analysis of local excision vs total mesorectal excision for middle and low rectal cancer in pT1/pT2 stage and intermediate pathological risk

Abstract

BackgroundLocal excision (LE) is a feasible treatment approach for rectal cancers in stage pT1 and presents low pathological risk, whereas total mesorectal excision (TME) is a reasonable treatment for more advanced cancers. On the basis of the pathology findings, surgeons may suggest TME for patients receiving LE. This study compared the survival outcomes between LE with/without chemoradiation and TME in mid and low rectal cancer patients in stage pT1/pT2, with highly selective intermediate pathological risk.MethodsThis retrospective study included 134 patients who received TME and 39 patients who underwent LE for the treatment of intermediate risk (pT1 with poor differentiation, lymphovascular invasion, perineural invasion, relatively large tumor, or small-sized pT2 tumor) rectal cancer between 1998 and 2016.ResultsOverall survival (OS), disease-free survival (DFS), and cumulative recurrence rate (CRR) were similar between the LE (3-year DFS 92%) and TME (3-year DFS 91%) groups. Following subgrouping into an LE with adjuvant therapy group and a TME without adjuvant therapy group, the compared survival outcomes (OS, DFS, and CRR) were found not to be statistically different. The temporary and permanent ostomy rates were higher in the TME group than in the LE group (p < 0.001). Rates of early and late morbidity following surgery were higher in the TME group (p = 0.005), and LE had similar survival compared with TME.ConclusionFor patients who had mid and low rectal cancer in stage pT1/pT2 and intermediate pathological risk, LE with chemoradiation presents an alternative treatment option for selected patients.

Adjuvant chemoradiotherapy versus radical surgery after transanal endoscopic microsurgery for intermediate pathological risk early rectal cancer: A single-center experience with long-term surveillance

“…Nearly 11% of the enrolled patients developed local or distant recurrence after initial TEM resection. The overall recurrence rate was consistent with previous reports [29]. The present study found no signi cant differences in 5-year OS and DFS between the different post-TEM treatment methods.…”

Does liver cirrhosis affect the surgical outcome of primary colorectal cancer surgery? A meta-analysis

“…Radical resection of the colorectal tumors has been widely accepted as a curative treatment [8]. Tumor location, comorbidity, clinical stage, anastomosis methods, and total mesorectal excision are reported to have an effect on the outcome of CRC surgery [9][10][11][12].…”

Local full-thickness excision for sessile adenoma and cT1-2 rectal cancer: long-term oncological outcome

“…In any case, the accepted range is 90–95% [ 36 , 37 ]. Recently published studies have presented similar rates of survival after local excision of pT1 and pT2 plus adjuvant therapy [ 38 , 39 ]. In our fully controlled patients, we encountered six cancer-related deaths, thus providing a survival rate of 94% (95.5% for pT1 and 90% for pT2 plus radiotherapy).…”