Our Summary

This study aimed to compare two different treatments for locally advanced non-metastatic rectal cancer. One treatment option is local excision (LE), which is a less invasive surgery that removes only the cancerous area. The other is proctectomy, a more invasive surgery that removes the entire rectum.

The researchers used data from the National Cancer Database and studied patients who had received pre-operative therapy for rectal cancer between 2004 and 2019. They compared the outcomes for patients who underwent LE or proctectomy.

The main result they were looking at was overall survival rate. They found that the average survival rate over 5 years was very similar for both groups (54.1 months for the LE group vs. 54.2 months for the proctectomy group).

Other factors such as whether the cancer was fully removed during surgery, the stage of the cancer, and mortality rates 30 and 90 days after surgery were also similar for both groups. However, patients who underwent LE tended to stay in the hospital for less time and were less likely to be readmitted within 30 days.

The study also found that certain characteristics, such as being male, having a higher Charlson score (a measure of how many other health conditions a patient has), and having poorly differentiated or mucinous adenocarcinomas (specific types of cancer) were linked to a higher risk of death. The type of surgery did not seem to affect the overall survival rate.

In conclusion, the study found no significant difference in survival rates between patients who underwent LE and those who underwent proctectomy. Patients with certain types of cancer had poorer outcomes, regardless of the type of surgery they had.

FAQs

  1. What were the two types of treatments compared in the study for locally advanced non-metastatic rectal cancer?
  2. What was the main result of the study regarding the survival rate of patients who underwent local excision and proctectomy?
  3. Did the study find specific patient characteristics that were linked to a higher risk of death?

Doctor’s Tip

However, it is important for patients to discuss with their doctor the potential risks and benefits of each type of surgery, as well as their individual circumstances and preferences. It is also important for patients to follow their doctor’s recommendations for post-operative care and follow-up appointments to ensure the best possible outcome.

Suitable For

Typically, patients with locally advanced non-metastatic rectal cancer who have received pre-operative therapy may be recommended for proctectomy. However, the decision to undergo proctectomy or local excision may depend on various factors such as the stage of the cancer, the extent of the tumor, the overall health of the patient, and the preferences of the patient and their healthcare team. It is important for patients to discuss their options with their healthcare provider to determine the most appropriate treatment plan for their individual situation.

Timeline

Before proctectomy:

  • Patient is diagnosed with locally advanced non-metastatic rectal cancer
  • Patient undergoes pre-operative therapy to shrink the tumor
  • Patient and healthcare team discuss treatment options, including local excision or proctectomy
  • Patient undergoes pre-operative tests and evaluations to determine eligibility for surgery
  • Patient prepares for surgery by following specific instructions from the healthcare team

After proctectomy:

  • Patient undergoes proctectomy surgery to remove the entire rectum
  • Patient stays in the hospital for a period of time to recover from surgery
  • Patient may experience pain, discomfort, and side effects from surgery
  • Patient receives post-operative care, including pain management, wound care, and physical therapy
  • Patient may need to adjust to life with a colostomy or ileostomy, depending on the type of proctectomy performed
  • Patient undergoes follow-up appointments and monitoring to ensure the cancer has been fully removed and to watch for any signs of recurrence or complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about proctectomy include:

  1. What are the potential risks and complications associated with a proctectomy surgery?
  2. How will my recovery process differ between a proctectomy and a local excision surgery?
  3. What are the long-term effects of having a proctectomy, such as changes in bowel function or quality of life?
  4. How will a proctectomy surgery impact my ability to participate in daily activities or return to work?
  5. What are the chances of the cancer recurring after a proctectomy compared to a local excision?
  6. Are there any alternative treatment options to consider before deciding on a proctectomy?
  7. How many proctectomy surgeries have you performed, and what is your experience with this procedure?
  8. Will I need to undergo additional treatments such as chemotherapy or radiation therapy after a proctectomy?
  9. How will my follow-up care and monitoring differ after a proctectomy compared to a local excision surgery?
  10. How can I best prepare myself physically and emotionally for a proctectomy surgery and the recovery process?

Reference

Authors: Horesh N, Emile SH, Freund MR, Garoufalia Z, Gefen R, Nagarajan A, Wexner SD. Journal: Tech Coloproctol. 2024 Sep 21;28(1):128. doi: 10.1007/s10151-024-02994-4. PMID: 39305380