Neoadjuvant Chemoradiation and Local Excision for T2-3 Rectal Cancer

Background: Local excision (LE) of T1 low-risk (G1–2/L0/V0) rectal cancer is an established approach with local recurrence (LR) rates of 5%, whereas LE of ‡T2 high-risk tumors or inadequate resections (R1/RX/R £1mm) showed high recurrence rates. Because of the favorable results after neoadjuvant chemoradiotherapy (nCRT) and radical surgery of disease that com-pletely responds (CR)with almost absent LReven ofT3–4 tumors, an extension of the indication for LE is controversially discussed, and therefore, we assessed this therapeutic option. Methods: Including our own data, seven studies about LE after nCRT of cT2–3 tumors (n = 237) were analyzed after a PubMed search for cT categories, tumor height, nCRT regi-mens, schedule and technique of surgery, complications, freedom of stoma, response rates (ypT0–3), length of follow-up, LR, and metastases. Results: Subgroups that we formed (retrospective vs. prospective/retractor vs. transanal endoscopic microsurgery) showed differences in the distribution of cT categories. However, neither the studies we considered nor our own patients showed LR in CR (ypT0). In addition, patients with ypT1 tumor consistently showed low LR rates of 2 % (range, 0%–6%), whereas in ypT2 findings, less favorable LR rates of 6 % to 20 % were observed, and disease that did no