Organ preservation strategies (by use of local excision) following a good response to neoadjuvant chemotherapy are an attractive proposition for patients with rectal cancer. However, multicentre randomised trials providing evidence of the benefits of local excision over total mesorectal excision (TME) were previously absent. Now, in the GRECCAR 2 study, good clinical responders were randomized to receive either local excision (n = 74) or TME (n = 71). At 2 years after surgery, one or more adverse events from a composite primary outcome occurred in 56% of the local excision group and 48% of the TME group (OR 1.33, 95% CI 0.62–2.86, P = 0.43). As 26 patients from the local excision group had a completion TME that increased morbidity, local excision was not shown to be superior to TME in terms of morbidity and long-term function.
Rullier, E. et al. Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial. Lancet http://dx.doi.org/10.1016/S0140-6736(17)31056-5 (2017)
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Dickson, I. No benefit for local excision over rectal excision. Nat Rev Gastroenterol Hepatol 14, 450 (2017). https://doi.org/10.1038/nrgastro.2017.96