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Background <p>Total mesorectal excision (TME) remains the standard of care for operable rectal cancer but is associated with significant long-term morbidity. Local excision (LE) following neoadjuvant therapy offers a potential organ-preserving alternative in selected patients. This systematic review evaluates oncological, functional, and safety outcomes from randomised trials comparing LE and TME in early rectal cancer.</p> Methods <p>A systematic review was conducted of randomised controlled trials comparing LE and TME in early-stage rectal adenocarcinoma. Trials were included if they enrolled predominantly cT2–T3N0 patients and compared either post-long course chemoradiotherapy (LCCRT) LE vs post-LCCRT TME, or neoadjuvant chemo(radiotherapy) + LE versus upfront TME. Primary outcomes were overall survival (OS) and disease-free survival (DFS); secondary outcomes included local/distant recurrence, functional outcomes, and health-related quality of life (HRQoL).</p> Results <p>Four trials (GRECCAR-2, Lezoche, TAUTEM, TREC; n = 514) met inclusion. Pathological complete response after LE ranged 26–44%, with 10–35% requiring completion TME. Within scenario-specific pools, there was no significant difference between LE and TME for OS or DFS, local or distant recurrence. LE was associated with lower major complications and better patient-reported outcomes.</p> Conclusion <p>In selected patients who receive neoadjuvant therapy, local excision is associated with lower morbidity and favourable functional outcomes compared with TME. While scenario-specific estimates suggest comparable survival, heterogeneity in design and follow-up limits firm conclusions on oncologic equivalence. Within response-adapted pathways with predefined criteria for completion TME, local excision is a feasible organ-preserving option.</p>

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Is radical surgery always necessary in early rectal cancer? A systematic review of randomised trials

  • 期刊论文

  • 发表日期：

    2025年11月24日

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  • Rathin Gosavi,
  • Thang Chien Nguyen,
  • Stephen Bell,
  • Paul McMurrick,
  • William Teoh,
  • Vignesh Narasimhan

摘要

Background

Total mesorectal excision (TME) remains the standard of care for operable rectal cancer but is associated with significant long-term morbidity. Local excision (LE) following neoadjuvant therapy offers a potential organ-preserving alternative in selected patients. This systematic review evaluates oncological, functional, and safety outcomes from randomised trials comparing LE and TME in early rectal cancer.

Methods

A systematic review was conducted of randomised controlled trials comparing LE and TME in early-stage rectal adenocarcinoma. Trials were included if they enrolled predominantly cT2–T3N0 patients and compared either post-long course chemoradiotherapy (LCCRT) LE vs post-LCCRT TME, or neoadjuvant chemo(radiotherapy) + LE versus upfront TME. Primary outcomes were overall survival (OS) and disease-free survival (DFS); secondary outcomes included local/distant recurrence, functional outcomes, and health-related quality of life (HRQoL).

Results

Four trials (GRECCAR-2, Lezoche, TAUTEM, TREC; n = 514) met inclusion. Pathological complete response after LE ranged 26–44%, with 10–35% requiring completion TME. Within scenario-specific pools, there was no significant difference between LE and TME for OS or DFS, local or distant recurrence. LE was associated with lower major complications and better patient-reported outcomes.

Conclusion

In selected patients who receive neoadjuvant therapy, local excision is associated with lower morbidity and favourable functional outcomes compared with TME. While scenario-specific estimates suggest comparable survival, heterogeneity in design and follow-up limits firm conclusions on oncologic equivalence. Within response-adapted pathways with predefined criteria for completion TME, local excision is a feasible organ-preserving option.