Colorectal Dis. 2021 Mar 16. doi: 10.1111/codi.15631. Online ahead of print.
ABSTRACT
AIM: Treatment of early rectal cancer (ERC) is undergoing a revolution towards rectum preservation. Adjuvant and neoadjuvant therapy alongside local excision (LE) means that organ preservation is a real possibility for most patients and a viable alternative for frailer patients. This study presents our 12-year experience as a specialist regional early rectal cancer unit, evolving towards organ preservation.
METHOD: Data was collected prospectively between 2006 – 2018 for all patients referred to the regional ERC multidisciplinary team (MDT) with suspected or confirmed ERC. Patients considered suitable for LE, or those declining radical surgery, were offered LE or neoadjuvant short course radiotherapy (SCRT), delay and LE with subsequent rescue surgery or contact brachytherapy for unfavourable histopathology.
RESULTS: 102 patients underwent LE. 10 patients were excluded (N=92). 45 patients underwent LE directly and 47 patients received SCRT and LE. After SCRT & LE, a pathological complete response was achieved in 44.7%. This approach also resulted in a lower rate of lymphovascular invasion (22.2% vs. 6.4%), fewer distant recurrences (4.4% vs 0%) and a better disease-specific mortality (11.1% vs 0%) (p<0.05). Although statistically insignificant, fewer patients required rescue surgery after SCRT(15.6% vs 4.3%).
CONCLUSION: Organ preservation with a good oncological outcome is better achieved by neoadjuvant radiotherapy, delay and LE. To achieve this, careful patient selection, thorough preoperative investigation, experienced surgical technique and a deep appreciation of tumour biology, managed via a dedicated early rectal cancer network is paramount.
PMID:33724612 | DOI:10.1111/codi.15631
