Is total mesorectal excision always necessary for T1-T2 lower rectal cancer?
ABSTRACT The goal of this multicenter study was to clarify the determinants of local excision for patients with T1-T2 lower rectal cancer.
Data from 567 consecutive patients who underwent radical resection for T1-T2 lower rectal cancer at 12 institutions between 1991 and 1998 were reviewed. Rates of lymph node metastasis were investigated using a tree analysis, which was hierarchized using independent risk factors for nodal involvement.
The independent risk factors for lymph node metastasis were female gender, depth of tumor invasion, histology other than well-differentiated adenocarcinoma, and lymphatic invasion. According to the first three parameters that can be obtained preoperatively, only 0.99% of the patients without risk factors had lymph node metastasis. On the other hand, even if the lower rectal cancer was at stage T1, women with histological types other than well-differentiated adenocarcinoma had an approximately 30% probability of having lymph node metastasis. Lymphatic invasion was most useful to predict nodal involvement among patients with T2 lower rectal cancer. The rates of lymph node metastasis in T2 patients with and without lymphatic invasion were 32.9% and 9.1%, respectively.
Gender is one of the most important predictors for lymph node metastasis in patients with early distal rectal cancer. Three parameters, including depth of tumor invasion, histology, and gender, are useful determinants for local excision. Additional studies are required to establish the minimum optimal treatment for T2 lower rectal cancer.
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ABSTRACT: T1 rectal cancer can be treated using various strategies. Endoscopic or transanal resection is the first choice of treatment when tumors are not associated with risk for lymph node metastasis. However, transabdominal resection with lymphadenectomy is recommended for tumors that do confer risk of lymph node metastasis. The prognosis after transabdominal resection is satisfactory, but various dysfunctions impair the postoperative quality of life. The standard treatment for T3–T4 rectal cancer is total mesorectal excision with preoperative chemoradiotherapy in Western countries and total mesorectal excision with laterallymph node dissection in Japan. Previous reports indicate that preoperative radiotherapy contributes to a lower rate of local recurrence, although overall survival is not affected. In addition, radiotherapy increases the prevalence of sexual dysfunction and fecal incontinence. The effect of perioperative chemoradiotherapy for T1–T2 rectal cancer remains unclear.Digestive Endoscopy 05/2013; 25(S2). DOI:10.1111/den.12068 · 1.99 Impact Factor
- Journal of Clinical Oncology 10/2013; 31(34). DOI:10.1200/JCO.2013.52.6434 · 17.88 Impact Factor
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ABSTRACT: Total mesorectal excision (TME) remains the gold standard for rectal cancer because it provides superior oncologic outcomes compared with local excision (LE). LE can be offered as an alternative for carefully selected patients; however, it must be emphasized that even in ideal patients, LE does not achieve equivalent results regarding oncologic outcomes compared with TME. With LE, patients trade a higher cancer cure rate for a lower risk of mortality and lower morbidity. The role of chemoradiation and LE in the treatment of rectal cancer is still under study.Surgical Oncology Clinics of North America 10/2010; 19(4):743-60. DOI:10.1016/j.soc.2010.08.002 · 1.67 Impact Factor