EARLY RECTAL CANCER: LOCAL EXCISION OR TOTAL MESORECTAL EXCISION?

AIM of this study was to improve treatment outcomes for early rectal cancer; to assess the accuracy of endorectal ultrasound (ERUS) in preoperative staging of early rectal cancer. MATERIAL AND METHODS. A total of 42 patients of the main prospective group with early rectal cancer underwent transanal local excision (LE). In control retrospective group 39 patients underwent radical resection with total mesorectal excision (TME). Operation time, perioperative, hospital stay duration long-term oncological results (overall and local recurrence-free survival, cancer-free survival, distant metastasis rate) were analyzed.. Comparison of ERUS preoperative staging for prospective group and pathological staging was performed to identify the accuracy of ERUS. RESULTS. Median follow-up for prospective group was 41 (from 10 to 60) months. In comparison with TME, LE was associated with fewer morbid (4,8 % vs 17,9 %, p=0,04). There was no hospital mortality in both groups. The accuracy of ERUS was 88,1 % for Tis and 78,6% for T1. There was no significant statistical difference in 1-year and 3-year in oncological outcomes between groups (p=1,0). There was one local recurrence (2,6%) in 6 months after LE in a patient with pT1sm3 who had previously refused surgery. This patient underwent TME. There was no detected distant metastasis in both groups. The 3-year overall survival was 100 % for LE and 97,4 % for TME. The 3-year cancer-specific survival was 100 % in both groups. CONCLUSIONS. LE has advantages over TME in short-term results; long-term oncological results after LE are comparable with TME. ERUS has a good diagnostic effectiveness in preoperative staging of early rectal cancer.

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Local Recurrence After Pure NOTES Transanal Total Mesorectal Excision for Early Rectal Cancer

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-021-05229-1 ◽

2022 ◽

Author(s):

Haipeng Meng ◽

Longyi Chen ◽

Ruichao Geng ◽

Fan Yang ◽

Rui Wang ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Total Mesorectal Excision ◽

Transanal Total Mesorectal Excision ◽

Early Rectal Cancer ◽

Mesorectal Excision

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The Impact of the Introduction of Total Mesorectal Excision on Local Recurrence Rate and Survival in Rectal Cancer: Long-Term Results

Annals of Surgical Oncology ◽

10.1245/s10434-011-1571-0 ◽

2011 ◽

Vol 18 (7) ◽

pp. 1899-1906 ◽

Cited By ~ 54

Author(s):

C. A. Maurer ◽

P. Renzulli ◽

C. Kull ◽

S. A. Käser ◽

L. Mazzucchelli ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Total Mesorectal Excision ◽

Recurrence Rate ◽

Local Recurrence Rate ◽

Long Term Results ◽

Mesorectal Excision ◽

The Impact

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Biology- and Location-Oriented Precision Treatment of Rectal Cancer: Present and Future

Visceral Medicine ◽

10.1159/000510488 ◽

2020 ◽

Vol 36 (5) ◽

pp. 381-387

Author(s):

Stefan Fichtner-Feigl

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Imaging Techniques ◽

Locally Advanced ◽

Preoperative Staging ◽

Tumor Resection ◽

Long Term Results ◽

Mesorectal Excision ◽

Treatment Pathways

Background: The surgical approach in rectal cancer treatment has evolved in the last decades and a standardized surgical technique for tumor resection – total mesorectal excision – has been established. Summary: In a multidisciplinary effort with the use of total mesorectal excision in combination with adjuvant and neoadjuvant treatments to compliment surgery disease management can achieve excellent long-term local control and improved patient survival. Further improvements in imaging techniques and the ability to identify prognostic factors such as tumor regression, extramural venous invasion, and threatened margins have introduced the concept of decision-making based on preoperative staging information. Key Message: Therefore, in the modern era treatment algorithms are based on high-resolution imaging to plan neoadjuvant therapy and precision surgery followed by pathological and molecular analysis to stratify patients for the need of adjuvant chemotherapy. Despite excellent results with guideline structured treatment pathways, there is still a need to improve long-term results especially for individuals with locally advanced or metastatic tumors.

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

Frontiers in Surgery ◽

10.3389/fsurg.2021.746784 ◽

2021 ◽

Vol 8 ◽

Author(s):

Julius Pacevicius ◽

Vidas Petrauskas ◽

Lukas Pilipavicius ◽

Audrius Dulskas

Keyword(s):

Rectal Cancer ◽

Postoperative Complications ◽

Total Mesorectal Excision ◽

Hospital Stay ◽

Local Excision ◽

Bowel Function ◽

Early Rectal Cancer ◽

Mesorectal Excision ◽

Oncological Outcomes

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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