Chemoradiation and local excision versus total mesorectal excision for T2N0 rectal cancer: Comparison of short- and long-term outcomes from 2 prospective studies Journal Article

   

Authors:	Lynn, P. B.; Van der Valk, M. J. M.; Claassen, Y. H. M.; Shi, Q.; Widmar, M.; Bastiaannet, E.; Van de Velde, C. J. H.; Garcia-Aguilar, J.
Article Title:	Chemoradiation and local excision versus total mesorectal excision for T2N0 rectal cancer: Comparison of short- and long-term outcomes from 2 prospective studies
Abstract:	Objective:Compare oncological long-term and short-term outcomes between patients with distal cT2NO rectal cancer treated with chemoradio-therapy and local excision (CRT + LE) and patients treated with total mesorectal excision (TME). Summary Background Data:Previous studies showed that CRT + LE is equivalent to TME in local tumor control and survival for T2N0 rectal cancer. Methods:Seventy-nine patients with cT2N0 rectal adenocarcinoma treated with CRT + LE in the ACOSOG Z6041 trial were compared to a cohort of 79 patients with pT2N0 tumors treated with upfront TME in the Dutch TME trial. Survival, short-term outcomes, and health-related quality of life (HRQOL) were compared between groups. Results:Three patients (4%) in the CRT + LE group required abdominoperineal resection, compared with 31 (40%) in the TME group. Forty TME patients (51%) required a permanent stoma. CRT-related toxicity occurred in 43% of the CRT + LE patients; however, TME patients had a higher rate of complications requiring reoperation (1 vs 9%; P = 0.03). Five-year disease-free survival {88.2% [confidence interval (CI), 77.7%-93.9%] vs 88.3% [CI, 78.7%-93.7%]; P = 0.88} and overall survival [90.3% (CI, 80.8%-95.3%) vs 88.4% (CI, 78.9%-93.8%); P = 0.82] were similar in the 2 groups. Compared to baseline, overall HRQOL decreased in the CRT + LE group and improved in the TME group. In both groups, patients with sphincter preservation had worse HRQOL scores 1 year after surgery. Conclusions: In patients who underwent CRT + LE, oncological outcomes were similar to those of patients who underwent TME, with fewer complications requiring reoperation but significant CRT toxicity. Although overall HRQOL decreased in the CRT + LE group and improved in TME patients, when considering anorectal function, results were worse in both groups.
Keywords:	radiotherapy; surgery; organ preservation; resection; rectal cancer; impact; quality-of-life; multicenter; preoperative; local excision; transanal endoscopic microsurgery; mesorectal excision; open-label; total; neoadjuvant chemoradiation; anorectal function
Journal Title:	Annals of Surgery
Volume:	277
Issue:	1
ISSN:	0003-4932
Publisher:	Lippincott Williams & Wilkins
Date Published:	2023-01-01
Start Page:	e96
End Page:	e102
Language:	English
ACCESSION:	WOS:000905219700030
DOI:	10.1097/sla.0000000000005052
PROVIDER:	wos
PMCID:	PMC8658950
PUBMED:	34225302
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Julio Garcia-Aguilar -- Source: Wos

https://synapse.mskcc.org/synapse/works/has_related_data_chk/202820