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International Journal of Colorectal Disease

, Volume 33, Issue 4, pp 383–391 | Cite as

Are we doing too much?: local excision before radical surgery in early rectal cancer

  • Sun Min Park
  • Bong-Hyeon Kye
  • Min Ki Kim
  • Heba E. Jalloun
  • Hyeon-Min Cho
  • In Kyu Lee
Original Article

Abstract

Purpose

In early rectal cancer cases, the use of local excision is increasing. The general indication for local excision is based on the preoperative stage, but there is often a discrepancy between pre and postoperative stages. We sought to determine the indications for local excision in T1 rectal adenocarcinoma patients by comparing the preoperative clinical and postoperative pathological stages. A second aim was to compare the oncologic outcomes between local excision and radical resection.

Methods

Between 2004 and 2014, 152 T1 rectal adenocarcinoma patients were enrolled. We divided the subjects into two groups, local excision and radical resection, depending on the modality of treatment the patients initially received. The group of patients who underwent radical resection was subsequently subdivided into “excisable” and “non-excisable” groups based on the postoperative pathology.

Results

Of 152 patients, 28 patients (18.4%) underwent local excision, while 124 patients (81.6%) underwent radical resection. Of 124 patients, in clinically suspected T2 or less and N0 (93) cases, 50 patients (53.8%) needed treatment beyond local excision, and local excision was sufficient for 43 patients (46.2%). The 3-year overall survival (p = 0.393) and 3-year disease-free survival (p = 0.076) between the local excision and radical resection groups showed no significant difference.

Conclusions

The clinical T stage was overestimated in more than half of the cases. Therefore, if cT1/2 tumors with cN0 are suspected preoperatively, local excision is initially recommended and will allow for determination of underlying pathology. The clinician can then decide whether to monitor or intervene with radical resection.

Keywords

Early rectal cancer Treatment Local excision Preop stage Indication 

Notes

Compliance with ethical standards

This study was approved by the Institutional Review Board of the Ethical Committee of the College of Medicine, The Catholic University of Korea (XC15RIMI0107K).

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sun Min Park
    • 1
  • Bong-Hyeon Kye
    • 1
  • Min Ki Kim
    • 1
  • Heba E. Jalloun
    • 1
  • Hyeon-Min Cho
    • 2
  • In Kyu Lee
    • 1
  1. 1.Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulKorea
  2. 2.Division of Colorectal Surgery, Department of Surgery, St. Vincent’s Hospital, College of MedicineThe Catholic University of KoreaSuwonKorea

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