Ann Surg Treat Res.  2022 Jan;102(1):36-45. 10.4174/astr.2022.102.1.36.

Short- and long-term outcomes of local excision with adjuvant radiotherapy in high-risk T1 rectal cancer patients

• Al-Sawat A
• Bae JH
• Kim HH
• Lee CS
• Han SR
• Lee YS
• Cho H
• Jang HS
• Lee IK

• KMID: 2523768
• DOI: http://doi.org/10.4174/astr.2022.102.1.36

Abstract

Purpose
The standard of care for early rectal cancer is radical surgery; however, it carries high postoperative morbidity. This study aimed to assess the short-term and oncological outcomes of local excision and adjuvant radiotherapy in patients with high-risk pathological stage (p) T1 rectal cancer.
Methods
Fifty-five patients underwent local excision with adjuvant radiotherapy or radical resection for high-risk T1 rectal cancer. Patients with adenocarcinoma within 10 cm from the anal verge; pT1 with high-risk features (grade 3–4); a tumor size of ≥3 cm; a positive margin; a lymphovascular or perineural invasion; or a submucosal invasion depth of ≥SM2 were included.
Results
The rates of postoperative complications and stoma formation were higher in the radical surgery group (P = 0.021 and P = 0.003, respectively). No significant differences were observed in the overall survival and disease-free survival (DFS) between the 2 groups (P = 0.301 and P = 0.076, respectively). Vascular invasion was a significantly poor prognostic factor for DFS (P = 0.033). The presence of 3 or more high-risk features was associated with a poor DFS (P = 0.002).
Conclusion
Local excision with adjuvant radiotherapy significantly reduces the risk of complications and stoma formation. It is also an alternative option for patients with fewer than 3 high-risk features.

Keyword

Lymphatic metastasis; Margins of excision; Rectal neoplasms; Risk factors

Figure

• 

  Fig. 1 A flowchart of the research. A total of 78 patients were enrolled in the study, 23 patients were excluded; 37 patients (67.3%) underwent radical resection, and 18 patients (32.7%) had local excision with adjuvant radiotherapy. pT1, pathological stage T1.

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  Fig. 2 After reviewing colonoscopic biopsy, patients underwent local excision or upfront radical resection depending on patients’ preference and surgeon experience. EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; TEM, transanal endoscopic microsurgery; TLE, transanal local excision; MDT, multidisciplinary team.

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  Fig. 3 Disease-free survival (DFS) for (A) local excision and radical resection groups, (B) vascular invasion as a risk factor, and (C) numbers of high-risk features factors.

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