In a nutshell
This study looked survival rates of stage II rectal cancer patients who underwent different treatments. It compared radical surgery versus local excision with added-on chemoradiation. The article concluded that overall survival was not different between the treatments.
Some background
Radical surgery (RS – complete removal of tumour and surrounding tissue) is the main treatment for stage II rectal cancer and has a high cure rate. However, it also carries several side effects including reduced bladder function, erection problems, and risk of poor function of bowel and rectum. Local excision (LE – removal of tumour at the site but not surrounding tissue) may not be enough in stage II rectal cancer due to risk of metastasis (cancer spread) and recurrence. Despite the risk, a lot of patients are treated with LE alone. Adding chemoradiation (CRT) to LE treatment has been suggested to lower this risk.
Methods & findings
4822 patients were analysed. 4367 (88%) underwent RS, 242 (7%) had CRT before LE, and 213 (5%) had CRT after LE.
The study found no difference among patient characteristics between the 3 groups. There was no difference found in overall survival (OS) between the 3 treatment groups.
Previous studies found that complications of RS such as bleeding at the site may affect outcomes. This may be due to delayed CRT treatment after surgery.
The bottom line
This study concluded that LE with CRT in stage II rectal cancer did not negatively affect OS compared to RS. Saving organ function with LE may be considered in favour of RS with associated complications.
The fine print
The study was limited by lack of information on recurrence of the cancer and information on attempts to preserve organ function. It also did not describe the details of the surgical procedures. Research should be conducted in a wider range of hospitals with greater access to patient and clinical data.
What’s next?
Talk with your doctor about the pros and cons of LE+CRT vs RS alone and discuss your individual priorities.
Published By :
Journal of Gastrointestinal Surgery
Date :
Aug 17, 2017
