Randomized clinical trial of endoluminal locoregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy
British Journal of Surgery, 08/03/2012
Lezoche E et al. – In selected patients, endoluminal locoregional resection (ELRR) had similar oncological results to total mesorectal excision (TME).Methods
- This prospective randomized trial compared endoluminal locoregional resection (ELRR) by transanal endoscopic microsurgery versus laparoscopic TME in the treatment of patients with small non–advanced low rectal cancer.
- Patients with rectal cancer staged clinically as cT2 N0 M0, histological grade G1–2, with a tumour less than 3 cm in diameter, within 6 cm of the anal verge, were randomized to ELRR or TME.
- All patients underwent long–course neoadjuvant chemoradiotherapy.
- Fifty patients in each group were analysed.
- Overall tumour downstaging and downsizing rates after neoadjuvant chemoradiotherapy were 51 and 26 per cent respectively, and were similar in both groups.
- All patients had R0 resection with tumour–free resection margins.
- At long–term follow–up, local recurrence had developed in four patients (8 per cent) after ELRR and three (6 per cent) after TME.
- Distant metastases were observed in two patients (4 per cent) in each group.
- There was no statistically significant difference in disease–free survival (P = 0•686).