Clinical outcome of local treatment and radical resection for pT1 rectal cancer.

Autor: Pai SS; Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Lin HH; Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. hhlin7@vghtpe.gov.tw.; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. hhlin7@vghtpe.gov.tw., Cheng HH; Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Huang SC; Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Lin CC; Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Lan YT; Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Wang HS; Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Yang SH; Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.; Division of Colon & Rectal Surgery, Department of Surgery, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan.; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Jiang JK; Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Chen WS; Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Lin JK; Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Chang SC; Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Jazyk: angličtina
Zdroj: International journal of colorectal disease [Int J Colorectal Dis] 2022 Aug; Vol. 37 (8), pp. 1845-1851. Date of Electronic Publication: 2022 Jul 19.
DOI: 10.1007/s00384-022-04220-9
Abstrakt: Background: Rectal cancer is mainly cured by radical resection with neoadjuvant chemoradiation or adjuvant chemotherapy. Pathological T1 lesions can be managed by local treatment and radiotherapy thereafter. Lower morbidity is the key benefit of these local treatments. Since nodal metastasis is important for staging, radical resection (RR) is suggested. Rectal cancer has higher surgical morbidity than colon cancer; local treatment has been the preferred choice by patients.
Methods: We retrospectively enrolled data of 244 patients with pT1 rectal adenocarcinoma. A total of 202 patients (82.8%) underwent RR, including low anterior resection (LAR) and abdomino-perineal resection (APR), and 42 patients (17.2%) underwent LT, including transanal excision and colonoscopic polypectomy.
Results: In our study, seven patients (16.7%) had loco-regional recurrence and distant metastasis from the LT group while eight patients (4.0%) had distant metastasis without loco-regional recurrence from the RR group. The lymph node metastasis rate in RR group was 8.4%. Forty-seven patients (24.2%) underwent LAR with temporary stoma, and its reversal rate was 100%. In the RR group, postoperative complication rate was 10.4% with a mortality rate of 0.5%. Recurrence-free survival (RFS) was 95.7% for RR and 80.2% for LT (P = 0.001), and overall survival (OS) was 93.7% for RR and 70.0% for LT (P = 0.001).
Conclusion: This study found that RFS and OS in patients of pT1 rectal adenocarcinoma that had received RR were better than receiving LT. Further adjuvant chemotherapy was possible for some RR patients. A higher recurrence rate after LT must be balanced against the morbidity and mortality associated with RR.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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