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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...

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Autores principales: Oh, Soo Young, Park, In Ja, Kim, Young IL, Lee, Jong-Lyul, Kim, Chan Wook, Yoon, Yong Sik, Lim, Seok-Byung, Yu, Chang Sik, Kim, Jin Cheon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8507625/
https://www.ncbi.nlm.nih.gov/pubmed/34638307
http://dx.doi.org/10.3390/cancers13194823
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author Oh, Soo Young
Park, In Ja
Kim, Young IL
Lee, Jong-Lyul
Kim, Chan Wook
Yoon, Yong Sik
Lim, Seok-Byung
Yu, Chang Sik
Kim, Jin Cheon
author_facet Oh, Soo Young
Park, In Ja
Kim, Young IL
Lee, Jong-Lyul
Kim, Chan Wook
Yoon, Yong Sik
Lim, Seok-Byung
Yu, Chang Sik
Kim, Jin Cheon
author_sort Oh, Soo Young
collection PubMed
description 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.
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spelling pubmed-85076252021-10-13 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 Oh, Soo Young Park, In Ja Kim, Young IL Lee, Jong-Lyul Kim, Chan Wook Yoon, Yong Sik Lim, Seok-Byung Yu, Chang Sik Kim, Jin Cheon Cancers (Basel) Article 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. MDPI 2021-09-27 /pmc/articles/PMC8507625/ /pubmed/34638307 http://dx.doi.org/10.3390/cancers13194823 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Oh, Soo Young
Park, In Ja
Kim, Young IL
Lee, Jong-Lyul
Kim, Chan Wook
Yoon, Yong Sik
Lim, Seok-Byung
Yu, Chang Sik
Kim, Jin Cheon
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8507625/
https://www.ncbi.nlm.nih.gov/pubmed/34638307
http://dx.doi.org/10.3390/cancers13194823
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