Total Mesorectal Excision Versus Local Excision After Favorable Response to Preoperative Chemoradiotherapy in “Early” Clinical T3 Rectal Cancer: A Propensity Score Analysis

Abstract Purpose The aim of this study was to compare oncological outcomes of total mesorectal excision (TME) and local excision (LE) in patients with "early" clinical T3 rectal cancer who received preoperative chemoradiotherapy (PCRT). Methods and Materials "Early" clinical T3 rectal cancer was radiologically defined as tumors with extramural extension of Results Of the 406 enrolled patients, 351 received TME and 55 received LE. The median follow-up period was 45 months. Following propensity score matching, each group contained 55 patients. Among 103 patients evaluable for pathologic tumor response, 82 patients (79.6%) showed complete response (CR) or near CR. No significant differences were observed between the TME and LE groups in LRFS (3-year LRFS 98.1% vs. 94.4%, p=0.312), DFS (3-year DFS 92.1% vs. 90.8%, p=0.683), and OS (3-year OS 98.2% vs. 100.0%, p=0.895). Conclusions In "early" clinical T3 rectal cancer, PCRT followed by LE showed comparable oncologic outcomes to TME. Because most of the matched cohort consisted of good responder to PCRT, current results should be applied to a limited population.