Early rectal cancer: when is local excision an option?

  • Halverson AL & al.
  • Ann Surg Oncol
  • 25 avr. 2019

  • Par Jim Kling
  • Résumés d'articles
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Takeaway

  • Local excision is associated with worse outcomes compared with radical resection in early rectal cancer, but may be an option in T1 tumors with no pathologic features.

Why this matters

  • Local excision has advantages with respect to morbidity and function, but patient selection remains an issue.

Study design

  • Systematic review of 16 studies.
  • Funding: None disclosed.

Key results

  • 8 studies confirmed that patients undergoing local excision had fewer postoperative complications. The largest study (n=2124) showed a rate of 5.6% vs 14.6% (P<.001>
  • 4 studies found that local excision was less likely to result in clear or negative margins.
  • It was unclear if functional outcomes at 1 year were better with localized excision.
  • 12 studies examined local recurrence rates and OS, and 6 showed higher recurrence rates with local excision.
  • 2 studies showed no difference in local recurrence with local excision in T1 tumors, but a higher rate of recurrence in T2 tumors.
  • 14 studies found a shorter OS associated with local excision, but the difference was statistically significant in only 5 studies. 1 study showed a difference in T2 tumors, but not T1.

Limitations

  • Most included studies were retrospective and none were randomized.