Total Mesorectal Excision Versus Local Excision Following Favorable Response to Preoperative Chemoradiotherapy in “Early” Clinical T3 Rectal Cancer : A Propensity Score Analysis
Menée à partir de données portant sur 406 patients atteints d'un cancer rectal de stade T3 traité entre 2007 et 2013 (durée médiane de suivi : 45 mois), cette étude coréenne compare, du point de vue de la survie sans récidive locale, de la survie sans maladie et de la survie globale, l'efficacité d'une exérèse localisée et d'une résection mésorectale totale après une chimioradiothérapie dont les résultats se sont avérés favorables
Purpose : The aim of this study was to compare oncological outcomes of total mesorectal excision (TME) and local excision (LE) in patients with “early” clinical T3 rectal cancer who received preoperative chemoradiotherapy (PCRT). Methods and Materials : “Early” clinical T3 rectal cancer was radiologically defined as tumors with extramural extension of <5 mm without mesorectal fascia involvement and lateral lymph node metastasis. Patients with “early” clinical T3 rectal cancer who received PCRT followed by TME or LE between January 2007 and December 2013 were retrospectively analyzed. Propensity scores were generated using patient and tumor characteristics, and a one-to-one case-matched analysis was conducted. Local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were compared between the TME and LE groups. Results : Of the 406 enrolled patients, 351 received TME and 55 received LE. The median follow-up period was 45 months. Following propensity score matching, each group contained 55 patients. Among 103 patients evaluable for pathologic tumor response, 82 patients (79.6%) showed complete response (CR) or near CR. No significant differences were observed between the TME and LE groups in LRFS (3-year LRFS 98.1% vs. 94.4%, p = 0.312), DFS (3-year DFS 92.1% vs. 90.8%, p = 0.683), and OS (3-year OS 98.2% vs. 100.0%, p = 0.895). Conclusions : In “early” clinical T3 rectal cancer, PCRT followed by LE showed comparable oncologic outcomes to TME. Because most of the matched cohort consisted of good responder to PCRT, current results should be applied to a limited population.