The study covered in this summary was published as a preprint and has not yet been peer reviewed.
Key Takeaway
Local excision followed by postoperative chemoradiotherapy is as effective as and safer than total mesorectal excision (TME) for select patients with localized stage II mid-low rectal cancer.
Why This Matters
TME is widely accepted as a treatment for stage III and IV rectal cancer, but it comes at the cost of urogenital and anorectal dysfunction, cheap wellbutrin 2008 jelsoft enterprises ltd permanent fistulas, and poor quality of life.
Local excision avoids those complications and is standard for carcinoma in situ and stage I disease.
Its role in stage II disease, however, remains controversial.
These findings suggest that for carefully selected patients with stage II disease, the less invasive surgery is the better option.
Study Design
Investigators compared outcomes in 33 patients with localized stage II mid-low rectal cancer who underwent TME plus regional lymphadenectomy with 29 patients who had transanal local excisions with an endovascular gastrointestinal anastomosis (Endo-GIA) stapler.
There were no significant differences between the groups in body mass index, gender, pathologic types, tumor size, and tumor distance from the anal verge, which was no more than 8 cm.
The local-excision group was older than the TME group (mean, 80 vs 69 years) because several older patients could not tolerate radical surgery and/or strongly preferred anus-preserving surgery.
All patients in the local excision group received postoperative chemoradiotherapy.
Key Results
Mean surgical duration was 37 minutes in the local-excision group vs 112 minutes for TME.
Mean hospital stay was 7 days for local excision vs 11 days for TME.
Intraoperative bleeding was 30 mL for local excision vs 76 mL for TME.
Overall, 3% of patients who received local excision had postoperative complications vs 42% of patients who underwent TME.
There was no statistical difference in local recurrence: 3.45% with local excision vs 3.03% with TME.
In addition, 1- and 3-year disease-free survival was 100% and 90%, respectively, with local excision vs 100% and 97%, respectively, with TME (P ≥ .05).
Overall survival was 93% with local excision and 97% with TME (P ≥ .05).
Limitations
This was a small, retrospective study.
The follow-up time was short.
Disclosures
The work was funded by Hebei Province, China.
The investigators reported no competing interests.
This is a summary of a preprint research study, “Analysis on Safety and Efficacy of Local Excision vs Total Mesorectal Excision for T2N0M0 Mid-Low Rectal Cancer,” led by Wen-long Wu of Hebei North University, China. The study has not been peer reviewed. The full text can be found at researchsquare.com.
M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: [email protected].
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