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PURPOSE: The purpose of this study was to compare the results of local excision (LE) with total mesorectal excision (TME) of early rectal cancer
METHODS: After IRB approval, medical records of patients with T1, T2 N0M0 rectal adenocarcinoma treated by curative LE or TME without preoperative radiotherapy from 2004 to 2012 were reviewed. Chi-square and ANOVA tests were used to compare categorical and continuous variables, respectively. Survival rates were compared using Kaplan-Mayer test
RESULTS: 153 patients were included in the study, 79 underwent TME and 74 LE. The two groups were similar in regards to age, gender, BMI, ASA score, co-morbidities, tumor location, size, grade and stage. In TME, the mean operative time was prolonged (196 vs. 77 min, P <0.00), the mean estimated blood loss was significantly more (214 vs. 26 ml, P <0.00) and hospital stay was significantly increased (7.4 vs. 2.5 days, P<0.001). No patient had stoma after LE compared to 48.7% after TME (P = 0.00). Postoperative infection was more common after TME (21.6 vs. 0%, P= 0.00.).Margins were involved by tumor in 13.5 % after LE compared to 0% after TME (P=0.00). 13.5% of patients treated initially by LE were re-operated for unfavorable histological findings and 4.1% had residual tumor. The mean follow up period was 35 months). In 56 patients with pT1, there was no mortality and although not statistically significant an increase in local recurrence after LE vs TME of 16.1 vs. 5.3%; P 0.20 and an increase in the estimated disease-free survival (DFS) after TME 76.6 vs. 62.8% (P= 0.18). In 68 patients with pT2, local recurrence was significantly higher after LE (42.8 vs 6.3%, P 0.00), the estimated DFS was higher after TME 81.5 vs. 44.5% (P= 0.003). However, there was no difference in the estimated overall survival, 82.8% vs. 79.4 %( P = 0.93)
CONCLUSIONS: LE of early rectal cancer is associated with a higher rate of local recurrence rates and decreased DFS. These disadvantages are especially significant for T2 lesions. Caution must be exercised when contemplating LE.