Ann Surg Treat Res.  2021 Aug;101(2):93-101. 10.4174/astr.2021.101.2.93.

Oncologic comparison between nonradical management and total mesorectal excision in good responders after chemoradiotherapy in patients with mid-to-low rectal cancer

• Lee JK
• Cho JR
• Song KS
• Oh JH
• Jeong SY
• Kim MJ
• Lee J
• Kim MH
• Oh HK
• Kim DW
• Kang SB
• on behalf of the Seoul Colorectal Research Group (SECOG) Collaborative

• KMID: 2519002
• DOI: http://doi.org/10.4174/astr.2021.101.2.93

Abstract

Purpose
This study was performed to compare the oncologic outcomes between nonradical management and total mesorectal excision in good responders after chemoradiotherapy.
Methods
We analyzed 75 patients, who underwent 14 watch-and-wait, 30 local excision, and 31 total mesorectal excision, in ycT0–1N0M0 based on magnetic resonance imaging after chemoradiotherapy for advanced mid-to-low rectal cancer in 3 referral hospitals. The nonradical management group underwent surveillance with additional sigmoidoscopy and rectal magnetic resonance imaging every 3–6 months within the first 2 years.
Results
Nonradical management group had more low-lying tumors (P < 0.001) and less lymph node metastasis based on magnetic resonance imaging (P = 0.004). However, cT stage, ycT, and ycN stage were not different between the 2 groups. With a median follow-up period of 64.7 months, the 5-year locoregional failure rate was higher in the nonradical management group than in the total mesorectal excision group (16.7% vs. 0%, P = 0.013). However, the 5-year overall survival and disease-free survival rates of the nonradical management and total mesorectal excision groups were not different (95.2% vs. 93.5%, P = 0.467; 76.4% vs. 83.6%, P = 0.665; respectively).
Conclusion
This study shows that nonradical management for ycT0–1N0 mid-to-low rectal cancer may be an alternative treatment to total mesorectal excision under proper surveillance and management for oncologic events.

Keyword

Chemoradiotherapy; Local excision; Nonradical management; Rectal neoplasms; Watch-and-wait

Figure

• 

  Fig. 1 Comparisons of the Kaplan-Meier survival curves of the nonradical management (NRM) and total mesorectal excision (TME) groups. (A) Overall survival (P = 0.467). (B) Disease-free survival (P = 0.665).

• 

  Fig. 2 Comparisons of the Kaplan-Meier survival curves of the nonradical management (NRM) and total mesorectal excision (TME) groups. (A) Locoregional failure-free survival (P = 0.013). (B) Distant metastasis-free survival (P = 0.269). *Statistically significant.

• 

  Fig. 3 Comparisons of the Kaplan-Meier survival curves of the watch-and-wait (WW) and local excision (LE) groups. (A) Overall survival (P = 0.866). (B) Disease-free survival (P = 0.818).

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