Early-rectal Cancer Treatment: A Decision-tree Making Based on Systematic Review and Meta-analysis

Aguirre–Allende, Ignacio; Enríquez-Navascués, José María; Elorza-Echaniz, Garazi; Etxart-Lopetegui, Ane; Borda-Arrizabalaga, Nerea; Ansorena, Yolanda Saralegui; Placer–Galán, Carlos

doi:10.1016/j.cireng.2021.02.007

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“…Recently, the issue of treatment of early rectal cancer brought even more attention. Two systematic reviews and meta-analyses have been just published ( 30 , 31 ). In both, the authors concluded that LE is safe for the treatment of early rectal cancer (this is T1 without poor prognostic factors).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%