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Local excision for more advanced rectal tumors.

Thomas Borschitz1, Werner Kneist, Ines Gockel

  • 1Clinic of General and Abdominal Surgery, Johannes Gutenberg-University Hospital, Mainz, Germany. borschit@mail.uni-mainz.de

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Local excision (LE) for T2 rectal cancer is controversial. LE alone is not recommended due to high recurrence rates, but it shows promise after neoadjuvant chemoradiotherapy (nCRT).

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastrointestinal Oncology

Background:

  • Local excision (LE) is established for T1 rectal cancer.
  • The role of LE for T2 rectal cancer remains controversial and under-investigated.
  • Limited data exists for LE in T2 tumors, necessitating further research.

Purpose of the Study:

  • To evaluate the oncological safety and efficacy of local excision (LE) for T2 rectal cancer.
  • To compare local recurrence (LR) rates after different treatment modalities for T2 rectal cancer.
  • To determine the optimal therapeutic approach for T2 rectal cancer based on recurrence rates.

Main Methods:

  • Retrospective analysis of local recurrence (LR) rates in T2 rectal cancer patients.
  • Comparison of LE alone, immediate radical reoperation, adjuvant (chemo)radiotherapy, and neoadjuvant chemoradiotherapy (nCRT) followed by LE.
  • Inclusion of own patient data (n=40) and PubMed search data (n=712).

Main Results:

  • Local excision (LE) alone for T2 rectal cancer resulted in a 19% LR rate, increasing to 52% with unfavorable findings.
  • Immediate radical reoperation decreased LR to 7%; adjuvant therapy showed 16% LR.
  • LE after neoadjuvant chemoradiotherapy (nCRT) demonstrated favorable results with a 9% LR rate.

Conclusions:

  • Local excision (LE) alone is not recommended for T2 rectal cancer due to high local recurrence (LR) rates.
  • Immediate conventional reoperation is a viable option for unexpected T2 findings after LE.
  • Neoadjuvant chemoradiotherapy (nCRT) followed by LE shows promising low LR rates, warranting further investigation in prospective studies.