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Post in Colorectal Surgery, Colorectal Cancer

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Is local or major surgery better for treating early rectal cancer with or without additional treatments before or after surgery?

Key messages

• We are uncertain if local excision (LE) (removal through the anus of an early rectal cancer that has not grown beyond the muscle layer of the rectum, or stage I) may shorten the period of being cancer‐free after surgery compared to radical resection (RR) (removing the entire rectum and its surrounding tissues through a major surgery). It is also unclear if LE affects cancer‐related survival related compared with RR.
• There is probably a large reduction in minor complications after surgery (only necessitating medications or supportive measures) with LE compared with RR for the treatment of early rectal cancer. It is unclear if LE lowers the rate of major complications.
• Based on only one study, LE results in better quality of life and anal sphincter function.

How is early rectal cancer treated?

The currently recommended treatment for stage I rectal cancer is a major surgery for removal of the rectum with all its surrounding supporting tissues, known as radical resection (RR). This extensive surgery carries significant risks of surgical and functional complications. Recently, an alternative treatment using advanced instruments through the anus has been popularized. This has enabled precise removal, or local excision (LE), of only the tumor safely through the anus with fewer complications and faster recovery. Sometimes additional therapies such as chemotherapy or radiotherapy may be used in conjunction before or after the surgery.

What did we find?

We found four studies that involved 266 participants with early rectal cancer with a median age of 60 years undergoing RR or LE. Participants were studied from 17.5 months in the shortest study to up to 9.6 years in the longest study.

Read more about the main findings in the full Cochrane Review.

What are the limitations of the evidence?

We have low confidence in the evidence mainly because it was based only on a few studies, and due to the way the studies were conducted. In addition, it is possible that the results of the studies could have been affected by the fact that participants and investigators were aware of which treatment participants had received.