Total Mesorectal Excision versus Local Excision Following Preoperative Chemoradiotherapy in Rectal Cancer with Lymph Node Metastasis: A Propensity Score-Matched Analysis
Menée en Corée du Sud à partir de données portant sur 96 patients atteints d'un cancer rectal avec métastases ganglionnaires (durée médiane de suivi : 54 mois), cette étude compare, du point de vue de la survie sans maladie et de la survie globale, l'intérêt d'une exérèse mésorectale totale et d'une exérèse locale après une chimioradiothérapie pré-opératoire
Background : Local excision (LE) in good responders to preoperative chemoradiotherapy (PCRT), which is considered as a good alternative to total mesorectal excision (TME) in early-stage rectal cancer, is not commonly recommended for node-positive (cN+) cases. This study aimed to determine whether LE outcomes were comparable to TME outcomes in cN+ rectal cancer patients who were good responders. Materials and Methods : This retrospective study included clinical T2-3 and cN+ low rectal cancer patient who received PCRT followed by TME or LE. Clinical stage T1 or T4 tumors, upper-to-middle rectal tumors (>7 cm from anal verge), and synchronous distant metastases were excluded. Lymph nodes ≥5 mm in size were defined as tumor-positive, and patients with metastatic lymph nodes >20 mm in size were excluded. Preoperative chemoradiotherapy comprised radiation (50–50.4 Gy/25–28 fractions over 5 weeks) with two cycles of 5-fluorouracil or oral capecitabine. Propensity scores were computed from tumor and patient variables and used for one-to-one matched analysis. Local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were compared between the two matched groups. Results : Between January 2007 and December 2013, 563 and 55 patients underwent TME and LE, respectively. Median follow-up period was 54 months. In propensity score-matched analysis, 48 patients were included in each group. No statistical differences were observed in 3-year LRFS (97.9% vs. 97.9%, p = 0.994), 3-year DFS (91.5% vs. 91.4%, p = 0.968), or 3-year OS (93.7% vs. 97.9%, p = 0.809) between TME and LE groups. Conclusions : In clinical N+ rectal cancer patients, oncological outcomes of PCRT followed by LE were comparable to those of TME; this finding might be applicable only to those patients with good response in the primary tumor and small lymph node metastases.
http://www.redjournal.org/article/S0360-3016(18)30331-6/fulltext 2018