Total Mesorectal Excision Versus Local Excision After Favorable Response to Preoperative Chemoradiotherapy in Early Clinical T3 Rectal Cancer: A Propensity Score Analysis

Purpose: To compare oncological outcomes of total mesorectal excision (TME) and local excision (LE) in patients with early clinical T3 rectal cancer who received pre-operative chemoradiotherapy (PCRT). Methods and Materials: Early clinical T3 rectal cancer was radiologically defined as tumors with extramural extension of <5 mm without mesorectal fascia involvement and lateral lymph node metastasis. Patients with early clinical T3 rectal cancer who received PCRT followed by TME or LE between January 2007 and December 2013 were retrospectively analyzed. Propensity scores were generated using patient and tumor characteristics, and a one-to-one case-matched analysis was conducted. Local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were compared between the TME and LE groups. Results: Of the 406 enrolled patients, 351 received TME and 55 received LE. The median follow-up period was 45 months. Following propensity score matching, each group contained 55 patients. Among 103 patients evaluable for pathologic tumor response, 82 patients (79.6%) showed complete response or near-complete response. No significant differences were observed between the TME and LE groups in LRFS (3-year LRFS 98.1% vs 94.4%, P=. 312), DFS (3-year DFS 92.1% vs 90.8%, P=. 683), and OS (3-year OS 98.2% vs 100.0%, P=. 895). Conclusions: In early clinical T3 rectal cancer, PCRT followed by LE showed comparable oncologic outcomes to TME. Because most of the matched cohort consisted of good responders to PCRT, the present results should be applied to a limited population. (C) 2017 Elsevier Inc. All rights reserved.