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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Local excision and postoperative radiation therapy for rectal adenocarcinoma
W M Mendenhall1, C G Morris, W R Rout
1Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610-0287, USA. mendewil@shands.ufl.edu
International Journal of Cancer
|May 7, 2002
Summary
Local excision with postoperative radiation therapy offers high local-regional control and survival for early-stage rectal adenocarcinoma. Margin status significantly impacts survival outcomes, while ulcerative tumors may reduce cause-specific survival.
Area of Science:
- Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- Early-stage rectal adenocarcinoma poses treatment challenges, especially for lesions unsuitable for local excision or endocavitary irradiation alone.
- Multimodal treatment strategies are crucial for optimizing outcomes in rectal cancer management.
Purpose of the Study:
- To evaluate the effectiveness of combining local excision with postoperative radiation therapy for early-stage rectal adenocarcinoma.
- To identify prognostic factors influencing treatment outcomes in this patient cohort.
Main Methods:
- Retrospective analysis of 67 patients with early-stage rectal adenocarcinoma treated between 1974 and 1999.
- Local excision followed by postoperative radiation therapy, with indications including positive margins and advanced histologic features.
- Cox proportional hazards regression analysis to assess the impact of variables like margin status and tumor configuration on survival endpoints.
Main Results:
- Five-year outcomes included 86% local-regional control, 93% ultimate local-regional control, 93% distant metastasis-free survival, 80% absolute survival, and 90% cause-specific survival.
- Positive margin status was a significant predictor of reduced absolute survival, cause-specific survival, and ultimate local-regional control.
- Ulcerative tumor configuration showed a marginal negative impact on cause-specific survival.
Conclusions:
- Local excision combined with postoperative radiation therapy is an effective treatment for selected patients with early-stage rectal adenocarcinoma, achieving high rates of local-regional control and survival.
- Margin status is a critical prognostic factor, underscoring the importance of achieving clear margins.
- Further investigation into the management of ulcerative rectal tumors may be warranted to improve cause-specific survival.
