Local excision of early rectal cancer is a less morbid alternative to major abdominal surgery.
Professor Alexander Engel and colleagues from Australia evaluated the role of local excision with neoadjuvant or adjuvant chemoradiotherapy.
The team identified a select group of patients where local excision is appropriate without significantly compromizing the oncological outcome.
MEDLINE, PubMed and the Cochrane Central Register of Controlled Trials databases were searched to identify relevant articles investigating the role of local excision with adjuvant or neoadjuvant chemoradiotherapy in patients with T1/T2N0M0 disease.
The researchers selected 11 studies comprising 455 patients.
|Median overall survival was 75%|
Oncological end-points included overall survival, disease-free and disease-specific survival, recurrence rates as well as perioperative morbidity and mortality.
At a range of 31 to 115 months, median overall survival, disease-specific and disease-free survival were 75%, 89%, and 74%, respectively.
The team found that median local, distant and overall recurrence rates were 10%, 5%, and 13%, respectively.
The researchers observed that mortality was 0% in all studies except one.
Most reported complications were minor and were treated conservatively.
Professor Engel's team concludes, "This systematic review provides data suggesting that selected patients with T1/T2N0M0 rectal cancer may undergo local excision without compromising the oncological outcome otherwise conferred by total mesorectal excision."
It may be a particularly useful option in patients in whom radical surgery is contraindicated."
"Randomized trials comparing both management strategies to consolidate this finding may lead to a paradigm change in the management of early rectal cancer."