Some patients with early-stage rectal cancer might be unsuitable for primary total mesorectal excision owing to the short-term surgical risks. A randomized, open-label feasibility study assessed the safety and efficacy of a short-course of radiotherapy followed by transanal endoscopic microsurgery, compared with total mesorectal excision, in patients with early-stage rectal cancer. At 15 UK sites, 55 patients with early-stage rectal adenocarcinoma (aged ≥18 years) were randomly assigned: 27 to the organ-preserving strategy and 28 to radical surgery. Of 27 patients assigned to organ preservation, 8 (30%) were converted to radical surgery. Serious adverse effects were reported in 4 of 27 (15%) patients randomly assigned to organ preservation versus 11 of 28 (39%) randomly assigned to total mesorectal excision (P = 0.04). Of 27 patients assigned to organ preservation, 8 (30%) achieved a complete response to radiotherapy. Patients in the organ-preservation group showed improvements in quality of life compared with patients undergoing radical surgery.
Bach, S. P. et al. Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study. Lancet Gastroenterol. Hepatol. https://doi.org/10.1016/S2468-1253(20)30333-2 (2020)
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Hindson, J. Organ preservation versus radical surgery for early-stage rectal cancer. Nat Rev Gastroenterol Hepatol 18, 82 (2021). https://doi.org/10.1038/s41575-021-00414-8