Lower early-stage rectal cancer surgical approaches: Therapeutic options and cancer biomarker alterations

Abstract

Abstract Background Early-stage rectal cancer is used in cases of histological findings including pTis and pT1 tumors, which are no metastases, no lymphovascular or perineural invasion, and located at the mucosa level of the intestinal wall. Low early-stage rectal cancer (LeREC), transanal resection can be an attractive alternative to less invasive surgical procedures and postoperative complications. However, none of the currently used surgical methods could be considered an ideal surgical option that is effective, safe, and painless. We hypothesized that a combination of the simplified transanal excision (sTE) and Ruiyun procedure for hemorrhoids (RPH) will increase the safety and effectiveness of surgical treatment low early-stage rectal cancer. Purpose To explore the safety and efficacy of the Transanal endoscopic microsurgery (TEM) or combining the sTE with RPH in the treatment of LeREC. Methods This is a randomized, controlled, balanced study of 48 patients with LeREC, who diagnosed with low early-stage rectal tumor less than 12 cm from the anal verge and were candidates for TEM or combining the sTE with RPH. Expression of CDK2, CDK4, CDK6, FOXD1 and PAK4 were determined in primary tumors from 48 patients with locally LeREC scheduled for TEM (20 cases) or RPH with the sTE (28 cases). The outcomes and postoperative complications were compared between 2 types of surgeries. Results Between Feb 1, 2015, and Dec 31, 2019, 48 patients were randomly assigned. 20 to TEM and 28 to combining sTE with RPH surgery. Then, all patients had been followed up within 12 months. Histopathological features for CDK2/4/6, FOXD1 and PAK4 proteins that would be considered to be associated with increased risk of tumor recurrence. Conclusions sTE combined with RPH can reduce the incidence of intraoperative bleeding, reduce the cost of surgery, facilitate diagnosis and treatment in grassroots hospitals, and improve the curative efficacy in the treatment of patients with lower two-thirds of early-stage rectal cancer.