Radical surgery is useful if high-risk cancer is discovered after local excision

This study examined whether radical surgery is a suitable follow-up approach to local excision if features indicating poor outcome are identified.

Local excision (removal of a small portion of tissue) is used as a cure for early rectal cancer. However, the reported levels of survival without disease are variable: ranging from 63 to 93%. The inclusion of high-risk patients in studies may account for this variability. Poor prognostic features (factors that predict for worse outcomes) in tissue biopsies (tissue removed from a living body to discover the presence or extent of cancer) can help diagnose high-risk cancer.

The best treatment approach if poor prognostic features are discovered after local excision is unclear. 

In this study the authors examined whether radical surgery (larger part of the rectum and intestine is removed) is a suitable treatment plan when poor prognostic features are found after local excision.

The study included 17 patients who had previously undergone radical surgery, after local excision, due to poor prognostic features. These features included: an aggressive tumor (23% of patients), mucinous adenocarcinoma (cancer of the mucus secreting glands; 6% of patients) and cancer cells found at the site after surgery (23% of patients). Cancer spread was also a poor prognostic feature, including spread to the lymph nodes (12% of patients), lymph vessels or blood vessels (41% of patients), to areas surrounding a nerve (6% of patients), or beyond the muscularis propria (the thick muscle layer of the colon; 50% of patients).

Combined radiotherapy and chemotherapy was given to 65% of the patients before radical surgery. Radical surgery occurred an average of 14 weeks after local excision. Average follow-up time was 110 months. Patients who underwent radical surgery had good overall cancer-specific survival (the percentage of patients who did not die directly from the cancer) at 88% after 5 years.

The authors recommended radical surgery after treatment with radiotherapy and/or chemotherapy if poor prognostic features are found.

The authors did not compare the success of radical surgery to any other treatment options.