The indication and surgical results of local excision following radiotherapy for low rectal cancer

Abstract

Local excision followed adjuvant radiotherapy is an alternative and feasible technique for small T1 rectal cancer in selected cases.

A systematic review of local excision followed by adjuvant therapy in early rectal cancer: are pT1 tumours the limit?

“…CT scans were used to detect metastatic disease in 17 out of these 20 studies. Local staging in the form of endoanal ultrasound alone was performed in eight studies , MRI alone in four studies and combined endoanal ultrasound and MRI in four studies . Endoscopic evaluation was reported by nine studies .…”

“…Radiotherapy dosing ranged from 15 to 67 Gy. Concomitant use of adjuvant chemotherapy was in the form of fluorouracil (5‐FU) in seven studies , 5‐FU/leucovorin in three studies and capecitabine in two studies . Eight studies reported the interval from local excision to commencement of adjuvant therapy and this was between 2 and 6 weeks postoperatively except for Valentini et al .…”

“…Insufficient data were available to permit the calculation of local recurrence with respect to local excision technique. Of those patients who developed a local recurrence, 71.6% underwent salvage surgery, most commonly in the form of an abdomino‐perineal resection . The overall median disease‐free survival was 88% across all studies (range 50%–100%), with a median overall survival of 76.4% (range 61%–100%).…”

“…Pretreatment staging modalities were disclosed by 20 studies [7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]29]. CT scans were used to detect metastatic disease in 17 out of these 20 studies.…”

“…Local staging in the form of endoanal ultrasound alone was performed in eight studies [7,[10][11][12][13][14][15][16], MRI alone in four studies [17][18][19][20] and combined endoanal ultrasound and MRI in four studies [9,[21][22][23]. Endoscopic evaluation was reported by nine studies [7,9,13,15,[17][18][19]24,25]. Two studies performed rigid sigmoidoscopy [10,22] and two studies proctoscopy [12,16].…”