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Local Excision After Preoperative Chemoradiation Results in an Equivalent Outcome to Total Mesorectal Excision in Selected Patients with T3 Rectal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We previously reported 26 patients who underwent preoperative chemoradiotherapy (CXRT) for T3 rectal cancer and were subsequently offered full-thickness local excision (LE) as an alternative to total mesorectal excision (TME). At nearly 4 years’ follow-up, no difference in outcome was observed. This study compares outcomes in a larger cohort of patients and reevaluates the original 26 patients after longer follow-up.

Methods

Retrospective review was performed of patients who underwent preoperative CXRT (radiation doses of 45, 50.4, or 52.5 Gy with concurrent 5-fluorouracil-based chemotherapy) followed by surgery for T3 rectal cancer. Forty-seven patients underwent LE (Kraske [n = 6] or transanal excision [n = 41]). 473 patients underwent TME (abdominoperineal resection [n = 141] or low anterior resection [n = 332]). Local recurrence, disease-free survival (DFS), disease-specific survival, and overall survival (OS) rates were compared.

Results

Median follow-up was 63 months for the LE group and 59 months for the TME group. Twenty-three LE patients (49%) had a complete response to CXRT, 17 (36%) had microscopic residual disease, and 7 (15%) had gross residual disease, compared with 108 (23%), 89 (19%), and 276 (58%) TME patients, respectively. There was no significant difference between the 10-year actuarial local recurrence rate for the LE group versus the TME group (10.6% and 7.6%, respectively; P = .52), and no significant difference in DFS, disease-specific survival, or OS rates between groups.

Conclusions

In selected patients who demonstrate an excellent response to preoperative CXRT for T3 rectal cancer, full-thickness LE offers comparable local control, DFS, and OS to that achieved with proctectomy and TME.

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Acknowledgment

We thank E. Lin and Wei Qiao for their assistance with statistical analysis.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Glenda G. Callender MD, Miguel A. Rodriguez-Bigas MD, John M. Skibber MD & Barry W. Feig MD

  2. Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Prajnan Das MD, Christopher H. Crane MD, Sunil Krishnan MD & Marc E. Delclos MD

Authors
  1. Glenda G. Callender MD
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  2. Prajnan Das MD
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  3. Miguel A. Rodriguez-Bigas MD
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  4. John M. Skibber MD
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  5. Christopher H. Crane MD
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  6. Sunil Krishnan MD
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  7. Marc E. Delclos MD
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  8. Barry W. Feig MD
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Corresponding author

Correspondence to Barry W. Feig MD.

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Callender, G.G., Das, P., Rodriguez-Bigas, M.A. et al. Local Excision After Preoperative Chemoradiation Results in an Equivalent Outcome to Total Mesorectal Excision in Selected Patients with T3 Rectal Cancer. Ann Surg Oncol 17, 441–447 (2010). https://doi.org/10.1245/s10434-009-0735-7

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  • DOI: https://doi.org/10.1245/s10434-009-0735-7

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