Local excision for ypT2 rectal cancer following preoperative chemoradiation therapy: it should not be justified

• Published in: International journal of colorectal disease Vol. 33; no. 4; pp. 487 - 491
• Main Authors: Yang, Kwan Mo, Lim, Seok-Byung, Lee, Jong Lyul, Kim, Chan Wook, Yoon, Yong Sik, Park, In Ja, Yu, Chang Sik, Kim, Jin Cheon
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2018; Springer; Springer Nature B.V
• Subjects: Cancer; Care and treatment; Chemoradiotherapy; Chemotherapy; Colorectal cancer; Gastroenterology; Health aspects; Hepatology; Internal Medicine; Medicine; Medicine & Public Health; Metastases; Metastasis; Oncology, Experimental; Proctology; Radiation therapy; Rectum; Short Communication; Surgery; Survival; Local excision; Oncological outcome; Preoperative chemoradiation therapy; Colorectal cancer
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-018-2973-2

Purpose Among individuals who respond well to preoperative chemoradiation therapy (CRT) for ypT0–1, local excision (LE) could provide acceptable oncological outcomes. However, in ypT2 cases, the oncological safety of LE has not been determined. This study aimed to compare oncological outcomes between LE and total mesorectal excision of ypT2-stage rectal cancer after chemoradiation therapy and investigate the oncological safety of LE in these patients. Methods We included 351 patients who exhibited ypT2-stage rectal cancer after CRT followed by LE ( n  = 16 [5%]) or total mesorectal excision (TME) ( n  = 335 [95%]) after preoperative CRT between January 2007 and December 2013. After propensity matching, oncological outcomes between LE group and TME group were compared. Results The median follow-up period was 57 months (range, 12–113 months). In the LE group, local recurrence occurred more frequently (18 vs. 4%; p  = 0.034) but not distant metastases (12 vs. 11%; p  = 0.690). The 5-year local recurrence-free (76 vs. 96%; p  = 0.006), disease-free (64 vs. 84%; p  = 0.075), and overall survival (79 vs. 93%; p  = 0.045) rates of the LE group were significantly lower than those of the TME group. After propensity matching, 5-year local recurrence-free survival of the LE group was significantly lower than that of the TME group (76 vs. 97%, p  = 0.029). Conclusion The high local failure rate and poor oncological outcomes for ypT2-stage rectal cancer patients who undergo CRT followed by LE cannot be justified as an indication for LE. Salvage surgery should be recommended in these patients.