International Journal of Colorectal Disease

, Volume 34, Issue 12, pp 2129–2136 | Cite as

Local excision in rectal cancer patients with major or complete clinical response after neoadjuvant therapy: a case-matched study

  • M. Bushati
  • S. PucciarelliEmail author
  • N. Gennaro
  • I. Maretto
  • P. Toppan
  • A. Perin
  • E. D. L. Urso
  • A. Bagatella
  • G. Spolverato
Original Article



To assess the long-term oncological outcomes in patients with locally advanced rectal cancer who underwent neoadjuvant therapy followed by local or total mesorectal excision.


Patients with locally advanced rectal adenocarcinoma who received neoadjuvant therapy from 2005 to 2017 were evaluated. Those with major or complete clinical response underwent a full-thickness local excision. Kaplan-Meier estimates were used to evaluate overall, disease-free, and local recurrence-free survival of patients who underwent local excision (LE group) and were compared with a matched cohort of patients who underwent total mesorectal excision (TME group).


Among 252 patients who received neoadjuvant therapy for rectal cancer, 51 (20.2%) underwent a local excision. At a median follow-up of 61 months, patients who underwent local excision were stoma-free in 88.2% of cases and with rectum preserved in 78.5% of cases, respectively. The estimated 5-year local, disease-free, and overall survival was 91.8% vs 97.6% (95% CI: 79.5–96.8 vs 84.6–99.6), 86.7% vs 86.4% (95% CI: 72.5–93.9 vs 70.1–94.1), and 85% vs 90% (95% CI: 69.0–93.0% vs 75.3–96.2), in the study and matched control group, respectively. None of the differences was statistically significant.


One-fifth of patients with locally advanced rectal cancer are manageable with a rectum-sparing approach after neoadjuvant therapy. With this strategy, about 80% patients will have their rectum preserved and 90% will be without stoma at long term.


Rectal cancer Neoadjuvant therapy Local excision Total mesorectal excision 



locally advanced rectal cancer


local excision


total mesorectal excision


transanal endoscopic microsurgery


neoadjuvant (chemo)radiotherapy


pathologic complete response


complete clinical response


major clinical response




local recurrence


distant recurrence


low anterior resection


abdominoperineal resection


quality of life


magnetic resonance imaging


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.1st Surgical Clinic, Department of Surgery, Oncology and GastroenterologyUniversity of PaduaPaduaItaly
  2. 2.Regional Health Service, Epidemiology UnitPaduaItaly

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