In a nutshell
This study investigated the outcomes of localized surgery following chemotherapy and radiation therapy (CRT) in rectal cancer. Researchers suggested that localized surgery should only be considered after a complete response to CRT.
Some background
Radical surgery or total mesorectal excision (TME; bowel and lymph nodes around the tumor are removed) is associated with a high rate of post-surgery complications (38-54% of patients) with a high impact on patients´ quality of life. Localized surgery is a less aggressive treatment. This type of surgery has been suggested to be a safe option to treat early tumors after a complete response to CRT (tumor shrinkage). However, the long-term outcomes of this treatment are not yet clear.
Methods & findings
The objective of this study was to determine the outcomes of rectal localized surgery and associated survival. This study also investigated the incidence of post-surgery complications.
Results from 20 previous studies were included in this analysis, including information about 1068 early-stage rectal cancer patients. The average follow-up period was 54 months.
44% saw a pathological complete response (absence of the tumor). In these patients, local recurrence (return of the cancer) rate was 4%. Average disease-free survival was 95%. In patients with a partial response after CRT local recurrence rate was higher (21.9%) and average disease-free survival was 68%.
The incidence of post-surgery complications was 23.3%. The most common complications were wound rupture (along the surgical incision; 9.9%) and rectal pain (10.7%).
The bottom line
This study suggested that localized surgery should only be considered after a complete response to CRT, given the high rate of local recurrence in rectal cancer patients with partial response.
Published By :
Diseases of the colon and rectum
Date :
Oct 01, 2016
