방사선의학 웹진

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Abstract

PURPOSE:

To compare oncological outcomes of total mesorectal excision (TME) and local excision (LE) in patients with "early" clinical T3 rectal cancer who received preoperative chemoradiotherapy (PCRT).

METHODS AND MATERIALS:

"Early" clinical T3 rectal cancer was radiologically defined as tumors with extramural extension of <5 mm without mesorectal fascia involvement and lateral lymph node metastasis. Patients with "early" clinical T3 rectal cancer who received PCRT followed by TME or LE between January 2007 and December 2013 were retrospectively analyzed. Propensity scores were generated using patient and tumor characteristics, and a one-to-one case-matched analysis was conducted. Local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were compared between the TME and LE groups.

RESULTS:

Of the 406 enrolled patients, 351 received TME and 55 received LE. The median follow-up period was 45 months. Following propensity score matching, each group contained 55 patients. Among 103 patients evaluable for pathologic tumor response, 82 patients (79.6%) showed complete response or near-complete response. No significant differences were observed between the TME and LE groups in LRFS (3-year LRFS 98.1% vs 94.4%, P=.312), DFS (3-year DFS 92.1% vs 90.8%, P=.683), and OS (3-year OS 98.2% vs 100.0%, P=.895).

CONCLUSIONS:

In "early" clinical T3 rectal cancer, PCRT followed by LE showed comparable oncologic outcomes to TME. Because most of the matched cohort consisted of good responders to PCRT, the present results should be applied to a limited population.​

Author information​

Shin YS1, Yu CS2, Park JH3, Kim JC2, Lim SB2, Park IJ2, Kim TW4, Hong YS4, Kim KP4, Yoon SM1, Joo JH1, Kim JH1.

1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

2 Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

3 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: jpark@amc.seoul.kr.

4 Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.