Local Excision versus Total Mesorectal Excision after favourable response to neoadjuvant therapy in rectal cancer: a multi-centre experience

Introduction: The gold standard surgical management of curable rectal cancer is proctectomy with total mesorectal excision. Adding preoperative radiotherapy improved local control. The promising results of neoadjuvant chemoradiotherapy raised the hopes for conservative, yet oncologically safe management, probably using local excision technique. Patients and Methods This study is a prospective comparative phase III study, where 46 rectal cancer patients were recruited from patients attending Oncology Centre of Mansoura University and Queen Alexandra Hospital Portsmouth University Hospital NHS with a median follow-up 36 months. The two recruited groups were as follows: Group (A): 18 patients who underwent conventional Radical Surgery by TME. Group (B): 28 patients who underwent Trans-anal Endoscopic Local Excision. Patients of resectable low rectal cancer (below 10 cms from anal verge) with sphincter saving procedures were included: cT1-T3N0. Results The median operative time for LE was 120 minutes versus 300 in TME (p < 0.001) , median blood loss was 20 ml versus 100 ml in LE and TME respectively (p < 0.001). Median hospital stay was 3.5 days versus 6.5 days (p = 0.009) . No statistically significant difference in median DFS (64.2 months for LE versus 63.2 months for TME, p = 0.85) and median OS (72.9 months for LE versus 76.3 months for TME, p = 0.43) . No statistically significant difference in LARS scores and QoL was observed between LE and TME (p = 0.798, p = 0.799) . Conclusion LE seems a good alternative to radical rectal resection in carefully selected responders to neoadjuvant therapy after thorough pre-operative evaluation, planning and patient counselling.