TY - JOUR T1 - Early-rectal Cancer Treatment: A Decision-tree Making Based on Systematic Review and Meta-analysis JO - Cirugía Española T2 - AU - Aguirre-Allende,Ignacio AU - Enriquez-Navascues,Jose Maria AU - Elorza-Echaniz,Garazi AU - Etxart-Lopetegui,Ane AU - Borda-Arrizabalaga,Nerea AU - Saralegui Ansorena,Yolanda AU - Placer-Galan,Carlos SN - 0009739X M3 - 10.1016/j.ciresp.2020.05.035 DO - 10.1016/j.ciresp.2020.05.035 UR - https://www.elsevier.es/es-revista-cirugia-espanola-36-articulo-early-rectal-cancer-treatment-a-decision-tree-S0009739X2030227X AB - Local excision (LE) has arisen as an alternative to total mesorectal excision for the treatment of early rectal cancer. Despite a decreased morbidity, there are still concerns about LE outcomes.This systematic-review and meta-analysis design is based on the “PICO” process, aiming to answer to three questions related to LE as primary treatment for early-rectal cancer, the optimal method for LE, and the potential role for completion treatment in high-risk histology tumors and outcomes of salvage surgery.The results revealed that reported overall survival (OS) and disease-specific survival (DSS) were 71%–91.7% and 80%–94% for LE, in contrast to 92.3%–94.3% and 94.4%–97% for radical surgery. Additional analysis of National Database studies revealed lower OS with LE (HR: 1.26; 95%CI, 1.09–1.45) and DSS (HR: 1.19; 95%CI, 1.01–1.41) after LE. Furthermore, patients receiving LE were significantly more prone develop local recurrence (RR: 3.44, 95%CI, 2.50–4.74). Analysis of available transanal surgical platforms was performed, finding no significant differences among them but reduced local recurrence compared to traditional transanal LE (OR:0.24;95%CI, 0.15–0.4). Finally, we found poor survival outcomes for patients undergoing salvage surgery, favoring completion treatment (chemoradiotherapy or surgery) when high-risk histology is present.In conclusion, LE could be considered adequate provided a full-thickness specimen can be achieved that the patient is informed about risk for potential requirement of completion treatment. Early-rectal cancer cases should be discussed in a multidisciplinary team, and patient's preferences must be considered in the decision-making process. ER -