Preliminary comparison of results of transanal endoscopic surgery and standard surgical procedures in patients with rectal cancer

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OBJECTIVE

To evaluate the efficacy of transanal endoscopic surgeries (TES) after neoadjuvant therapy (NAT) in rectal cancer (RC) compared to standard surgeries (SS).

MATERIAL AND METHODS

The study included 299 RC patients with tumor stage T1-3N0-1M0. Of these, 36 patients (Group 1) underwent TES, and 263 patients (Group 2) had SS. Some patients received NAT: a course of external beam radiation therapy at a dose of 46—60 Gy combined with capecitabine at a dose of 2 g/m² (in two doses) daily during the radiation therapy course and subsequent courses of consolidating polychemotherapy in the XELOX regimen. Pseudo-randomization was performed for group comparability: patients without regional metastases with comparable invasion depth and nearly identical regression coefficients in terms of tumor size and volume were selected from Group 2 into Group 3. After pseudo-randomization, there were 72 patients left: 36 after TES (Group 1) and 36 after SS (Group 3).

RESULTS

In Group 1, progression was detected in 3 (8.3%) out of 36 patients, while in Group 3, among 36 patients, 6 (16.7%) showed progression (p=0.2851). The overall 5-year survival rate in Group 1 was 78.5%, and in Group 3, it was 83% (p=0.51282). Progression-free survival in Group 1 was 76%, and in Group 3, it was 77% (p=0.40086). NAT was administered to 27 (75.0%) of 36 patients in Group 1 and to 3 (8.3%) of 36 patients in Group 3 (p=0.00001). However, given the unfavorable prognosis in lower rectal RC, sphincter-preserving surgeries, are acceptable only after NAT, and surgical treatment is effective only for T2N0M0 stage performing abdominal-perineal resection of the rectum.

CONCLUSION

Performing TES after NAT shows progression-free survival rates comparable to standard surgeries in the context of surgical treatment. Considering the unfavorable prognosis in lower rectal RC, even after NAT, preference should be given to standard surgeries.

Keywords:

rectal cancer

neoadjuvant therapy

transanal endoscopic surgery

minimally invasive surgery

long-term outcomes

Authors:

V.A. Solodkiy

Russian Research Center of Radiology

SPIN RSCI: 440543
Scopus AuthorID: 57204298158
ResearcherID: T-6803-2017
ORCID: 0000-0002-1641-6452

S.V. Goncharov

Russian Scientific Center of Roentgenoradiology

SPIN RSCI: 2722-7264
Scopus AuthorID: 57204090222
ORCID: 0000-0001-7914-1882

O.A. Vlasov

Federal State Budgetary Institution «Russian Scientific Center of Roentgenoradiology» Ministry of Health of Russia

ORCID: 0000-0003-0695-5177

Yu.A. Barsukov

Blokhin National Medical Research Center of Oncology

Received:

21.07.2023

Accepted:

09.08.2023

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