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Preservation of the rectum is possible in early rectal cancer with neoadjuvant radiotherapy, delay and local excision—a 12‐year single‐centre experience of the evolution of early rectal cancer treatment
Author(s) -
Bilkhu Amarvir,
Robinson Jonathan Matthew,
Steward Mark Arnold
Publication year - 2021
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.15631
Subject(s) - medicine , radiation therapy , rectum , neoadjuvant therapy , lymphovascular invasion , surgery , colorectal cancer , total mesorectal excision , cancer , radical surgery , histopathology , general surgery , metastasis , pathology , breast cancer
Aim Treatment of early rectal cancer (ERC) is undergoing a revolution towards rectum preservation. Adjuvant and neoadjuvant therapy alongside local excision (LE) means that organ preservation is a real possibility for most patients and a viable alternative for frailer patients. This study presents our 12‐year experience as a specialist regional ERC unit, evolving towards organ preservation. Method Data were collected prospectively between 2006 and 2018 for all patients referred to the regional ERC multidisciplinary team with suspected or confirmed ERC. Patients considered suitable for LE, or those declining radical surgery, were offered LE or neoadjuvant short‐course radiotherapy (SCRT), delay and LE with subsequent rescue surgery or contact brachytherapy for unfavourable histopathology. Results In all, 102 patients underwent LE. Ten patients were excluded ( N = 92). 45 patients underwent LE directly and 47 patients received SCRT and LE. After SCRT and LE, a pathological complete response was achieved in 44.7%. This approach also resulted in a lower rate of lymphovascular invasion (22.2% vs. 6.4%), fewer distant recurrences (4.4% vs. 0%) and a better disease‐specific mortality (11.1% vs. 0%) ( P < 0.05). Although statistically insignificant, fewer patients required rescue surgery after SCRT (15.6% vs. 4.3%). Conclusion Organ preservation with a good oncological outcome is better achieved by neoadjuvant radiotherapy, delay and LE. To achieve this, careful patient selection, thorough preoperative investigation, experienced surgical technique and a deep appreciation of tumour biology managed via a dedicated ERC network is paramount.