Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates

SIMPLE SUMMARY: Rectal cancer with good clinical response after preoperative chemoradiotherapy (PCRT) have shown favorable outcomes. As favorable oncologic outcomes in patients with good response to PCRT emerged, it dawned on many colorectal surgeons that the rectum can be saved without compromising the prognosis of rectal cancer. However, evidence was not sufficient yet, and it was necessary to determine the factors associated with oncologic outcomes after local excision. The purpose of our study was to compare the oncologic outcomes between local excision and radical resection in ypT0-1 patients and verify the oncologic safety of local excision. Our study provides valid surgery principles by analyzing the prognostic factors of each strategy, further reinforcing the evidence of rectum sparing treatment for rectal cancer patients. ABSTRACT: Tumors with good response to preoperative chemoradiotherapy have a favorable prognosis, and these findings raise interest in rectum-sparing strategies. This study aimed to compare the oncologic outcome between local excision and radical resection in ypT0-1 patients and to analyze prognostic factors. Patients with primary rectal cancer diagnosed with ypT0-1 after PCRT followed by either radical resection (RR) or local excision (LE) between 2005 and 2014 were included in this study (LE = 78, RR = 442). Clinicopathologic features, recurrence-free survival (RFS), and OS were analyzed. There was no statistically significant difference in the RFS and OS between the LE and RR groups. Clinical T stage (cT3-4) before PCRT was related to RFS and in the LE group (p = 0.022). Lymph node metastasis (HR: 4.884, 95% confidence interval: 2.451–9.732, p < 0.001) in the final pathology was the only factor associated with RFS, showing a statistically significant difference in the RR group. Lymph node metastasis and age were associated with OS in the RR group. This study confirms the oncologic feasibility of LE in ypT0-1 rectal cancer after PCRT. Additionally, careful patient selection with higher accuracy modalities should be updated to improve treatment outcomes of LE.