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Abstract
PURPOSE:
To determine whether local excision (LE) outcomes were comparable to total mesorectal excision (TME) outcomes in node-positive (cN+) rectal cancer patients who were good responders.

METHODS AND MATERIALS:
This retrospective study included clinical T2-3 and cN+ low rectal cancer patient who received preoperative chemoradiotherapy (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 2 cycles of 5-fluorouracil or oral capecitabine. Propensity scores were computed from tumor and patient variables and used for 1-to-1 matched analysis. Local recurrence-free survival, disease-free survival, and overall survival were compared between the 2 matched groups.

RESULTS:
Between January 2007 and December 2013, 563 and 55 patients underwent TME and LE, respectively. The 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 local recurrence-free survival (97.9% vs 97.9%, P = .994), 3-year disease-free survival (91.5% vs 91.4%, P = .968), or 3-year OS (93.7% vs 97.9%, P = .809) between the TME and LE groups.

CONCLUSIONS:
In clinical N+ rectal cancer patients, oncologic 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.

Author information

Shin YS1, Park JH1, Yoon SM1, Kim JC2, Yu CS2, Lim SB2, Park IJ2, Kim TW3, Hong YS3, Kim KP3, Choi EK1, Ahn SD1, Lee SW1, Kim JH4.
1
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
2
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
3
Department of Medical Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
4
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: jhkim2@amc.seoul.kr.