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KMID : 0371420211010020093
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Annals of Surgical Treatment and Research
2021 Volume.101 No. 2 p.93 ~ p.101
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Oncologic comparison between nonradical management and total mesorectal excision in good responders after chemoradiotherapy in patients with mid-to-low rectal cancer
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Lee Ja-Kyung
Cho Jung-Rae
Song Kwang-Seop
Oh Jae-Hwan
Jeong Seung-Yong
Kim Min-Jung
Lee Jee-Hye
Kim Min-Hyun
Oh Heung-Kwon
Kim Duck-Woo
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Abstract
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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.
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KEYWORD
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Chemoradiotherapy, Local excision, Nonradical management, Rectal neoplasms, Watch-and-wait
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