Citation: Colorectal Dis. 2021 Apr 26. Online ahead of print.
Author: Javed MA, Shamim S, Slawik S, Andrews T, Montazeri A, Ahmed S
Abstract: INTRODUCTION: Management of early rectal cancer following transanal microscopic anal surgery (TEMS) poses a management dilemma when the histopathology reveals poor prognostic features, due to high risk of local recurrence (LR). The aim of this study is to evaluate the oncological outcomes of such patients who either undergo surgery with total mesorectal excision (TME), receive adjuvant chemo/radiotherapy (CRDT/RT) or close surveillance only (no further treatment). METHODS: We identified patients with poor prognostic factors; pT2 adenocarcinoma, poor differentiation, deep submucosal invasion (kikuchi - SM3), lymphovascular invasion, tumour budding or R1 resection margin between 01.09.2012 and 31.01.2020 and report their oncological outcomes. RESULTS: Of the 53 patients; 18 had TME, 14 had CRDT and 14 had RT, seven patients did not have any further treatment. Median follow-up was 48 months, 12 developed recurrence and six died. Overall, 5-year survival (OS) was 88.9% and disease-free survival (DFS) was 79.2%. Compared to the surgical group, in which there were eight recurrences and two deaths, there were zero recurrences or deaths in the CRDT group, log-rank test p = 0.206 for OS and p = 0.005 for DFS. The 5-year survival rates in RT and surveillance only groups were OS 78.6%, DFS 85.7% and OS 71.5% and 71% respectively. TME assessment in the surgical group revealed grade 3 quality in seven of the 16 available reports. CONCLUSION: These findings support the strategy of adjuvant CRDT as first line treatment for patients undergoing TEMS for ERC with poor prognostic factors on initial histological assessment.
