Retrospective analysis of 19 cases with middle-to-low rectal cancer who underwent local excision following neoadjuvant chemoradiation / 中国实用外科杂志

ABSTRACT

OBJECTIVE: To investigate the prognosis and quality of life of patients who underwent transanal local excision(LE) following neoadjuvant chemoradiation for mid-low rectal cancer.METHODS: Patients undergo neoadjuvant chemoradiaiton and transanal local excision from March 2011 to June 2016 in Gastrointestinal cancer center,Peking University Cancer Hospital were enrolled in this study. Data of 19 cases were retrospectively collected and analyzed. The primary end points were disease free survival,short-term(1 month)postoperative complications; and secondary endpoints were quality of life and anal function one year after the surgery.RESULTS: Median tumor diameter was 1.0(0.3-3.0)cm. 8(42.1%) cases located in the anterior wall,6 cases(31.6%) in the posterior wall,3 cases(15.8%) in the left wall,and 2 cases(10.5%) in the right wall. The median distance of the tumor from the anal verge was 4.0(1.5-12.0)cm. Postoperative pathology demonstrated that 12 cases(63.2%) ypT0,3 cases(15.8%) ypT1,4 cases(21.1%) ypT2;the median time interval between chemoradiotherapy and LE was 4.3(2.0-36.0)months;The median time of operation was 50(20-137)min,with median blood loss 10(0-50)ml and hospital stay 4(1-5)d. The recurrence rate was 21.1%(1 local recurrence, 2 lung metastasis, 1 pelvic metastasis) with a follow up of 30(2-62) months.TME group had worse quality of life and anal function following TME surgery(P<0.01) while LE group not. LE group has better quality of life(EORTC-C30) and anal function(Wexner) than TME group(P<0.01).CONCLUSION: For mid-low rectal cancer with good response(ycT0-2 N0) following neoadjuvant chemoradiation,local excision might be a safe and feasible treatment option with acceptable anal function anal function.