Early-rectal Cancer Treatment: A Decision-tree Making Based on Systematic Review and Meta-analysis
| Autor: | José María Enríquez-Navascués, N. Borda‐Arrizabalaga, G. Elorza‐Echaniz, Yolanda Saralegui Ansorena, Carlos Placer-Galan, Ane Etxart-Lopetegui, Ignacio Aguirre-Allende |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Local excision business.industry Colorectal cancer General surgery Decision tree General Engineering Cancer 030230 surgery medicine.disease Total mesorectal excision 03 medical and health sciences 0302 clinical medicine Meta-analysis medicine Surgery Radical surgery business Chemoradiotherapy |
| Zdroj: | Cirugía Española (English Edition). 99:89-107 |
| ISSN: | 2173-5077 |
| Popis: | Local excision (LE) has arisen as an alternative to total mesorectal excision for the treatment of early rectal cancer. Despite a decreased morbidity, there are still concerns about LE outcomes. This systematic-review and meta-analysis design is based on the "PICO" process, aiming to answer to three questions related to LE as primary treatment for early-rectal cancer, the optimal method for LE, and the potential role for completion treatment in high-risk histology tumors and outcomes of salvage surgery. The results revealed that reported overall survival (OS) and disease-specific survival (DSS) were 71%-91.7% and 80%-94% for LE, in contrast to 92.3%-94.3% and 94.4%-97% for radical surgery. Additional analysis of National Database studies revealed lower OS with LE (HR: 1.26; 95%CI, 1.09-1.45) and DSS (HR: 1.19; 95%CI, 1.01-1.41) after LE. Furthermore, patients receiving LE were significantly more prone develop local recurrence (RR: 3.44, 95%CI, 2.50-4.74). Analysis of available transanal surgical platforms was performed, finding no significant differences among them but reduced local recurrence compared to traditional transanal LE (OR:0.24;95%CI, 0.15-0.4). Finally, we found poor survival outcomes for patients undergoing salvage surgery, favoring completion treatment (chemoradiotherapy or surgery) when high-risk histology is present. In conclusion, LE could be considered adequate provided a full-thickness specimen can be achieved that the patient is informed about risk for potential requirement of completion treatment. Early-rectal cancer cases should be discussed in a multidisciplinary team, and patient's preferences must be considered in the decision-making process. |
| Databáze: | OpenAIRE |
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