부산대학교 도서관

BACKGROUND:: In patients with locally advanced extraperitoneal rectal cancer, a multidisciplinary approach with preoperative radiochemotherapy and surgery with total mesorectal excision represents the standard treatment. In patients who obtain a major or complete response, radical surgery might represent overtreatment, considering the favorable prognosis of these cases. OBJECTIVE:: To evaluate postoperative short-term morbidity, functional outcome, and oncologic long-term outcome in patients with rectal cancer treated with local excision by transanal endoscopic microsurgery or by radical surgery and who obtained a complete or major pathological response (ypT0-1) after neoadjuvant treatment. DESIGN:: This was a retrospective study. SETTING:: The study was conducted at a single center. PATIENTS:: Patients treated, after neoadjuvant treatment (1996-2016), by local excision with a major or complete pathological response at histological examination (transanal endoscopic microsurgery group) were compared to patients treated by radical surgery with the same pathological response (total mesorectal excision group). INTERVENTIONS:: Local excision by transanal endoscopic microsurgery and radical surgery with total mesorectal excision. MAIN OUTCOME MEASURES:: Postoperative short-term morbidity, functional outcome 1 year after surgery (evaluated with an evacuation and continence score) and oncologic long-term outcome. RESULTS:: Ninety-three patients were included in the study (35 transanal endoscopic microsurgery group; 58 total mesorectal excision group). In the total mesorectal excision group, a sphincter-saving approach was possible in 89.7% (vs 100%; p = 0.049); a protective temporary stoma was necessary in 74.1% of radical procedures (vs 0%; p < 0.001) and 13.8% of these became permanent. Short-term postoperative morbidity was lower after local excision (14.3% vs 46.6%; p = 0.002). One year after surgery, the transanal endoscopic microsurgery group recorded a better evacuation and continence function than the total mesorectal excision group. After a mean follow-up of 67 months, oncologic outcome was similar between the groups. LIMITATIONS:: Limitations of this study include its retrospective design. CONCLUSION:: If a major or complete pathological response occurs after neoadjuvant treatment, an organ-sparing approach by local excision seems to offer the same oncologic results as radical surgery but has a better postoperative morbidity rate and better functional results 1 year after surgery. See Video Abstract at http://links.lww.com/DCR/B901.