Kwan Mo Yang1, Seok-Byung Lim2, Jong Lyul Lee1, Chan Wook Kim1, Yong Sik Yoon1, In Ja Park1, Chang Sik Yu1, Jin Cheon Kim1. 1. Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea. 2. Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea. sblim@amc.seoul.kr.
Abstract
PURPOSE: Among individuals who respond well to preoperative chemoradiation therapy (CRT) for ypT0-1, local excision (LE) could provide acceptable oncological outcomes. However, in ypT2 cases, the oncological safety of LE has not been determined. This study aimed to compare oncological outcomes between LE and total mesorectal excision of ypT2-stage rectal cancer after chemoradiation therapy and investigate the oncological safety of LE in these patients. METHODS: We included 351 patients who exhibited ypT2-stage rectal cancer after CRT followed by LE (n = 16 [5%]) or total mesorectal excision (TME) (n = 335 [95%]) after preoperative CRT between January 2007 and December 2013. After propensity matching, oncological outcomes between LE group and TME group were compared. RESULTS: The median follow-up period was 57 months (range, 12-113 months). In the LE group, local recurrence occurred more frequently (18 vs. 4%; p = 0.034) but not distant metastases (12 vs. 11%; p = 0.690). The 5-year local recurrence-free (76 vs. 96%; p = 0.006), disease-free (64 vs. 84%; p = 0.075), and overall survival (79 vs. 93%; p = 0.045) rates of the LE group were significantly lower than those of the TME group. After propensity matching, 5-year local recurrence-free survival of the LE group was significantly lower than that of the TME group (76 vs. 97%, p = 0.029). CONCLUSION: The high local failure rate and poor oncological outcomes for ypT2-stage rectal cancer patients who undergo CRT followed by LE cannot be justified as an indication for LE. Salvage surgery should be recommended in these patients.
PURPOSE: Among individuals who respond well to preoperative chemoradiation therapy (CRT) for ypT0-1, local excision (LE) could provide acceptable oncological outcomes. However, in ypT2 cases, the oncological safety of LE has not been determined. This study aimed to compare oncological outcomes between LE and total mesorectal excision of ypT2-stage rectal cancer after chemoradiation therapy and investigate the oncological safety of LE in these patients. METHODS: We included 351 patients who exhibited ypT2-stage rectal cancer after CRT followed by LE (n = 16 [5%]) or total mesorectal excision (TME) (n = 335 [95%]) after preoperative CRT between January 2007 and December 2013. After propensity matching, oncological outcomes between LE group and TME group were compared. RESULTS: The median follow-up period was 57 months (range, 12-113 months). In the LE group, local recurrence occurred more frequently (18 vs. 4%; p = 0.034) but not distant metastases (12 vs. 11%; p = 0.690). The 5-year local recurrence-free (76 vs. 96%; p = 0.006), disease-free (64 vs. 84%; p = 0.075), and overall survival (79 vs. 93%; p = 0.045) rates of the LE group were significantly lower than those of the TME group. After propensity matching, 5-year local recurrence-free survival of the LE group was significantly lower than that of the TME group (76 vs. 97%, p = 0.029). CONCLUSION: The high local failure rate and poor oncological outcomes for ypT2-stage rectal cancerpatients who undergo CRT followed by LE cannot be justified as an indication for LE. Salvage surgery should be recommended in these patients.
Entities:
Keywords:
Colorectal cancer; Local excision; Oncological outcome; Preoperative chemoradiation therapy
Authors: M Verseveld; E J R de Graaf; C Verhoef; E van Meerten; C J A Punt; I H J T de Hingh; I D Nagtegaal; J J M E Nuyttens; C A M Marijnen; J H W de Wilt Journal: Br J Surg Date: 2015-04-02 Impact factor: 6.939
Authors: Monique Maas; Patty J Nelemans; Vincenzo Valentini; Prajnan Das; Claus Rödel; Li-Jen Kuo; Felipe A Calvo; Julio García-Aguilar; Rob Glynne-Jones; Karin Haustermans; Mohammed Mohiuddin; Salvatore Pucciarelli; William Small; Javier Suárez; George Theodoropoulos; Sebastiano Biondo; Regina G H Beets-Tan; Geerard L Beets Journal: Lancet Oncol Date: 2010-08-06 Impact factor: 41.316
Authors: Thomas Borschitz; Daniel Wachtlin; Markus Möhler; Heinz Schmidberger; Theodor Junginger Journal: Ann Surg Oncol Date: 2007-12-28 Impact factor: 5.344
Authors: In Ja Park; Y Nancy You; John M Skibber; Miguel A Rodriguez-Bigas; Barry Feig; Sa Nguyen; Chung-Yuan Hu; George J Chang Journal: Dis Colon Rectum Date: 2013-02 Impact factor: 4.585
Authors: Nam Kwon Lee; Dae Yong Kim; Sun Young Kim; Jae Hwan Oh; Won Park; Doo Ho Choi; Taek-Keun Nam; Kyung-Ja Lee Journal: Cancer Res Treat Date: 2014-04-22 Impact factor: 4.679
Authors: Sung Min Jung; Chang Sik Yu; In Ja Park; Tae Won Kim; Jong Hoon Kim; Yong Sik Yoon; Seok-Byung Lim; Jin Cheon Kim Journal: Medicine (Baltimore) Date: 2016-05 Impact factor: 1.889
Authors: Jee Yeon Kim; In Ja Park; Seung Mo Hong; Jong Lyul Lee; Yong Sik Yoon; Chan Wook Kim; Seok-Byung Lim; Jung Bok Lee; Chang Sik Yu; Jin Cheon Kim Journal: Medicine (Baltimore) Date: 2015-12 Impact factor: 1.817