Local Excision Versus Total Mesorectal Excision After Favourable Response to Neoadjuvant Therapy in Low Rectal Cancer: a Multi-centre Experience

The gold standard surgical management of curable rectal cancer is proctectomy with total mesorectal excision. Adding preoperative radiotherapy improved local control . The promising results of neoadjuvant chemoradiotherapy raised the hopes for conservative, yet oncologically safe management, probably using local excision technique. This study is a prospective comparative phase III study, where 46 rectal cancer patients were recruited from patients attending Oncology Centre of Mansoura University and Queen Alexandra Hospital Portsmouth University Hospital NHS with a median follow-up 36 months. The two recruited groups were as follows: g roup (A), 18 patients who underwent conventional radical surgery by TME; and group (B), 28 patients who underwent trans-anal endoscopic local excision. Patients of resectable low rectal cancer (below 10 cms from anal verge) with sphincter saving procedures were included: cT1-T3N0. The median operative time for LE was 120 min versus 300 in TME (p < 0.001) , and median blood loss was 20 ml versus 100 ml in LE and TME, respectively ( p < 0.001). Median hospital stay was 3.5 days versus 6.5 days (p = 0.009) . No statistically significant difference in median DFS (64.2 months for LE versus 63.2 months for TME, p = 0.85 ) and median OS (72.9 months for LE versus 76.3 months for TME, p = 0.43 ). No statistically significant difference in LARS scores and QoL was observed between LE and TME ( p = 0.798 , p = 0.799 ). LE seems a good alternative to radical rectal resection in carefully selected responders to neoadjuvant therapy after thorough pre-operative evaluation, planning and patient counselling.