Radical vs. Local Excision in Rectal Carcinoma T1N0M0: Recurrence and Mortality Rates

Abstract

Local transanal excision of early rectal carcinoma is an appealing treatment because of its low morbidity rates and better functional results than radical resection. However, this treatment approach is controversial due to its association with local recurrence when compared to the latter. This review aims to compare the local recurrence and mortality rates of local vs. radical excision in patients with T1N0M0 rectal carcinoma, based on data in the literature in the last 20 years. A PubMed, Cochrane, and Google Scholar search of published literature in the last 20 years was performed. A total of 12 studies were identified. Three were prospective, one was a population-based propensity matching study, one was a nationwide cohort study, one was a meta-analysis, and the remaining studies were retrospective/observational. The mean local recurrence rate within five years from the studies selected for local excision (LE: 12.8%) was nearly double that of radical excision (RAD: 5.0%). The five-year mean survival rate for both LE and RAD groups from the studies selected was 86%, which was equal for both groups. The main predictors of poor outcomes were older age and the presence of two or more comorbid conditions. There is a consensus amongst studies that LE is associated with inferior oncological outcomes such as postoperative complications and recurrence when compared to RAD. The higher local recurrence rates in LE are attributed to occult lymph node disease and inadequate adjunctive therapy due to suboptimal staging. There is no difference in the five-year survival rate when compared to RAD. A longer follow-up period is needed to determine whether the survival rates diverge after five years.

Can pre-treatment MRI and CT radiomics improve prediction of complete pathological response in locally advanced rectal cancer following neoadjuvant treatment?

“…Being able to predict patients who are unlikely to achieve a pCR can help identify high-risk patients who may need more aggressive treatment to improve their outcomes. There may be potential in escalating therapy in predicted nonresponders and offer local excision or wait-and-watch strategies in patients more likely to have a pCR (5)(6)(7)(8)(9)(10). Thus, being able to predict the outcome of nCRT before initiating treatment can optimise choice of treatment and can avoid overtreatment or undertreatment.…”