Open AccessLocal recurrence after local excision of early rectal cancer: a meta‐analysis of completion TME, adjuvant (chemo)radiation, or no additional treatment
Author(s) -
Oostendorp S. E.,
Smits L. J. H.,
Vroom Y.,
Detering R.,
Heymans M. W.,
Moons L. M. G.,
Tanis P. J.,
Graaf E. J. R.,
Cunningham C.,
Denost Q.,
Kusters M.,
Tuynman J. B.
Publication year - 2020
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.12040
Subject(s) - medicine , wide local excision , surgery , colorectal cancer , radiation therapy , total mesorectal excision , adjuvant radiotherapy , meta analysis , cancer
Background The risks of local recurrence and treatment‐related morbidity need to be balanced after local excision of early rectal cancer. The aim of this meta‐analysis was to determine oncological outcomes after local excision of pT1–2 rectal cancer followed by no additional treatment (NAT), completion total mesorectal excision (cTME) or adjuvant (chemo)radiotherapy (aCRT). Methods A systematic search was conducted in PubMed, Embase and the Cochrane Library. The primary outcome was local recurrence. Statistical analysis included calculation of the weighted average of proportions. Results Some 73 studies comprising 4674 patients were included in the analysis. Sixty‐two evaluated NAT, 13 cTME and 28 aCRT. The local recurrence rate for NAT among low‐risk pT1 tumours was 6·7 (95 per cent c.i. 4·8 to 9·3) per cent. There were no local recurrences of low‐risk pT1 tumours after cTME or aCRT. The local recurrence rate for high‐risk pT1 tumours was 13·6 (8·0 to 22·0) per cent for local excision only, 4·1 (1·7 to 9·4) per cent for cTME and 3·9 (2·0 to 7·5) per cent for aCRT. Local recurrence rates for pT2 tumours were 28·9 (22·3 to 36·4) per cent with NAT, 4 (1 to 13) per cent after cTME and 14·7 (11·2 to 19·0) per cent after aCRT. Conclusion There is a substantial risk of local recurrence in patients who receive no additional treatment after local excision, especially those with high‐risk pT1 and pT2 rectal cancer. The lowest recurrence risk is provided by cTME; aCRT has outcomes comparable to those of cTME for high‐risk pT1 tumours, but shows a higher risk for pT2 tumours.