The study covered in this summary was published as a preprint and has not yet been peer reviewed.
Key Takeaway
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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
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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, permanent fistulas, and poor quality of life.
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Local excision avoids those complications and is standard for carcinoma in situ and stage I disease.
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Its role in stage II disease, however, remains controversial.
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These findings suggest that for carefully selected patients with stage II disease, the less invasive surgery is the better option.
Study Design
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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.
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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.
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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.
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All patients in the local excision group received postoperative chemoradiotherapy.
Key Results
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Mean surgical duration was 37 minutes in the local-excision group vs 112 minutes for TME.
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Mean hospital stay was 7 days for local excision vs 11 days for TME.
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Intraoperative bleeding was 30 mL for local excision vs 76 mL for TME.
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Overall, 3% of patients who received local excision had postoperative complications vs 42% of patients who underwent TME.
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There was no statistical difference in local recurrence: 3.45% with local excision vs 3.03% with TME.
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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).
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Overall survival was 93% with local excision and 97% with TME (P ≥ .05).
Limitations
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This was a small, retrospective study.
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The follow-up time was short.
Disclosures
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The work was funded by Hebei Province, China.
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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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