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Local resection versus radical resection for early-stage rectal cancer: a systematic review and meta-analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The optimal surgical approach for early-stage rectal cancer remains controversial. Radical resection is considered to be the gold standard for rectal cancer treatment. More and more studies show that local resection can replace traditional radical resection in the treatment of early rectal cancer. This research aimed to compare the efficacy of local excision and radical surgery for early-stage rectal cancer and report the evidence-based clinical advantages of both techniques.

Methods

The clinical trials comparing oncological and perioperative local and radical resection outcomes for early-stage rectal cancer were searched from 7 national and international databases.

Results

Finally, 3 randomized controlled trials and 14 cohort studies were included. In terms of oncology and perioperative outcomes, there were no statistically significant differences between the radical resection group and the local resection group in terms of OS (HR = 1.05, 95% CI (0.98, 1.13), DFS [HR = 1.18, 95% CI (0.93, 1.48), p = 0.168), distant metastasis rate (RR = 1.04, 95% CI (0.49, 2.20), p = 0.928), and mortality rate (RR = 1.52, 95% CI (0.80, 2.91), p = 0.200). However, there were significant differences in the outcomes of complications (RR = 2.85, 95% CI (2.07, 3.92), p < 0.001), length of hospital stays (WMD = 5.41, 95% CI (3.94, 6.87), p < 0.001), stoma rate (RR = 7.69, 95% CI (2.39, 24.77), p = 0.001), local recurrence rate (RR = 0.48, 95% CI (0.27, 0.86), p = 0.013), operative time (WMD = 74.68, 95% CI (68.00, 81.36), p < 0.001), blood loss (WMD = 156.36, 95% CI (95.48, 217.21, p < 0.001), and adverse events (RR = 1.59, 95% CI (1.05, 2.41), p = 0.027).

Conclusion

Local excision may be a viable alternative to radical resection for early-stage rectal cancer, but higher quality clinical studies are needed to confirm this.

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Acknowledgements

We would like to thank the researchers and study participants for their contributions.

Funding

This work was supported by grant number cstc2019jcyj-msxmX0711 from the Natural Science Foundation of Chongqing Municipal Science and Technology Commission (to Q.Z.).

Author information

Author notes

  1. Shufa Tan and Chenxi Xu contributed equally to this work

Authors and Affiliations

  1. Shaanxi University of Chinese Medicine, Shaanxi, China

    Shufa Tan, Shikai Chen, Yanrong Zhan, Jiyun Wu, Zhenfu Sun & Bozhi Ren

  2. Fuling Hospital Affiliated to Chongqing University, 2 Gaosuntang Road, Fuling District, Chongqing City, 408099, China

    Chenxi Xu, Hongbo Ma & Qi Zhou

  3. Shanghai University of Chinese Medicine, Shanghai, China

    Yunyi Yang

  4. Department of Anorectal, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, No. 2, Weiyang West Road, Qindu District, Xianyang City, 712099, Shaanxi, China

    Yaping Cu

Authors
  1. Shufa Tan
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  2. Chenxi Xu
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  3. Hongbo Ma
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  4. Shikai Chen
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  10. Qi Zhou
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Contributions

Conceptualization: Shufa Tan. Methodology: Shufa Tan, Chenxi Xu, Hongbo Ma, Yanrong Zhan, Jiyun Wu, Bozhi Ren, Zhenfu Sun. Formal analysis and investigation: Shufa Tan, Chenxi Xu. Writing—original draft preparation: Shufa Tan. Writing—review and editing: Shufa Tan, Chenxi Xu. Funding acquisition: Hongbo Ma, Shikai Chen, Yunyi Yang, Yaping Cu. Resources: Shufa Tan. Supervision: Qi Zhou, Yaping Cu.

Corresponding authors

Correspondence to Qi Zhou or Yaping Cu.

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Tan, S., Xu, C., Ma, H. et al. Local resection versus radical resection for early-stage rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 37, 1467–1483 (2022). https://doi.org/10.1007/s00384-022-04186-8

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  • DOI: https://doi.org/10.1007/s00384-022-04186-8

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