• Patricio B Lynn, Maxime J M Van der Valk, Yvette H M Claassen, Qian Shi, Maria Widmar, Ester Bastiaannet, Van de VeldeCornelis J HCJHSurgery Department, Leiden University, Leiden, The Netherlands., and Julio Garcia-Aguilar.
• Department of General Surgery, NYU Langone Health, New York, NY.
• Ann. Surg. 2023 Jan 1; 277 (1): e96e102e96-e102.

ObjectiveCompare oncological long-term and short-term outcomes between patients with distal cT2NO rectal cancer treated with chemoradio-therapy and local excision (CRT + LE) and patients treated with total mesorectal excision (TME).Summary Background DataPrevious studies showed that CRT + LE is equivalent to TME in local tumor control and survival for T2N0 rectal cancer.MethodsSeventy-nine patients with cT2N0 rectal adenocarcinoma treated with CRT + LE in the ACOSOG Z6041 trial were compared to a cohort of 79 patients with pT2N0 tumors treated with upfront TME in the Dutch TME trial. Survival, short-term outcomes, and health-related quality of life (HRQOL) were compared between groups.ResultsThree patients (4%) in the CRT + LE group required abdominoperineal resection, compared with 31 (40%) in the TME group. Forty TME patients (51%) required a permanent stoma. CRT-related toxicity occurred in 43% of the CRT + LE patients; however, TME patients had a higher rate of complications requiring reoperation (1 vs 9%; P = 0 .03). Five-year disease-free survival {88.2% [confidence interval (CI), 77.7%-93.9%] vs 88.3% [CI, 78.7%-93.7%]; P = 0.88} and overall survival [90.3% (CI, 80.8%-95.3%) vs 88.4% (CI, 78.9%-93.8%); P = 0 .82] were similar in the 2 groups. Compared to baseline, overall HRQOL decreased in the CRT + LE group and improved in the TME group. In both groups, patients with sphincter preservation had worse HRQOL scores 1 year after surgery. Conclusions: In patients who underwent CRT + LE, oncological outcomes were similar to those of patients who underwent TME, with fewer complications requiring reoperation but significant CRT toxicity. Although overall HRQOL decreased in the CRT + LE group and improved in TME patients, when considering anorectal function, results were worse in both groups.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

11 keywords...

hide…