Local Excision Safe, Effective for Stage II Rectal Cancer

M. Alexander Otto, PA, MMS

September 12, 2022

The study covered in this summary was published as a preprint and has not yet been peer reviewed.

Key Takeaway

  • 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

  • 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.

  • Local excision avoids those complications and is standard for carcinoma in situ and stage I disease.

  • Its role in stage II disease, however, remains controversial.

  • These findings suggest that for carefully selected patients with stage II disease, the less invasive surgery is the better option.

Study Design

  • 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.

  • 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.

  • 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.

  • All patients in the local excision group received postoperative chemoradiotherapy.

Key Results

  • Mean surgical duration was 37 minutes in the local-excision group vs 112 minutes for TME.

  • Mean hospital stay was 7 days for local excision vs 11 days for TME.

  • Intraoperative bleeding was 30 mL for local excision vs 76 mL for TME.

  • Overall, 3% of patients who received local excision had postoperative complications vs 42% of patients who underwent TME.

  • There was no statistical difference in local recurrence: 3.45% with local excision vs 3.03% with TME.

  • 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).

  • Overall survival was 93% with local excision and 97% with TME (P ≥ .05).

Limitations

  • This was a small, retrospective study.

  • The follow-up time was short.

Disclosures

  • The work was funded by Hebei Province, China.

  • 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: aotto@mdedge.com.

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