Adjuvant Chemoradiotherapy Versus Radical Surgery After Transanal Endoscopic Microsurgery for Intermediate Pathological Risk Early Rectal Cancer: a Single Center Experience With Long-term Surveillance

Abstract BackgroundThe choice of subsequent treatment for intermediate risk rectal tumors after Transanal endoscopic microsurgery (TEM) between adjuvant chemoradiotherapy and total mesorectal excision (TME) is controversial. The present study aimed to compare survival and functional outcome between these two strategies. Methods This retrospective study included intermediate risk early rectal cancer patients after TEM in our center between 2010 and 2017. Patients were divided into adjuvant treatment and TME groups. Intermediate risk was defined as pT1 with lymphovascular invasion, poor differentiation or large diameter (3-5 cm) or pT2 with small diameter(less than 3cm). The study was based on follow-up data on survival and results from distributed validated scales for functional outcome. ResultsPostoperative overall survival (OS) and disease-free survival (DFS) were comparable between groups (p = 0.619 and p = 0.712 respectively). Pathological T stage was an independent risk factor for DFS (HR 3.09, 95% CI 1.66 - 4.18, p = 0.044). Anorectal symptoms, such as buttock pain, was significantly prevalent in the TME group (p = 0.030). TME group presented with poorer bowel function, including stool urgency (p < 0.001), bowel frequency (p = 0.016), severity of LARS (p = 0.039) and total LARS score (p = 0.040). Except for a lower score of vaginal lubrication in TME group than the adjuvant treatment group, sexual function was similar between the groups. ConclusionLike TME, adjuvant chemoradiotherapy is an alternative option for intermediate risk early rectal cancer after TEM and is associated with similar survival outcomes and better bowel function.