Local excision vs. proctectomy in patients with ypT0-1 rectal cancer following neoadjuvant therapy: a propensity score matched analysis of the National Cancer Database.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Techniques in Coloproctology Pub Date : 2024-09-21 DOI:10.1007/s10151-024-02994-4

N Horesh, S H Emile, M R Freund, Z Garoufalia, R Gefen, A Nagarajan, S D Wexner

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Abstract

Background: We aimed to evaluate outcomes of organ preservation by local excision (LE) compared to proctectomy following neoadjuvant therapy for rectal cancer.

Methods: This retrospective observational study using the National Cancer Database (NCDB) included patients with locally advanced non-metastatic rectal cancer (ypT0-1 tumors) treated with neoadjuvant therapy between 2004 and 2019. Outcomes of patients who underwent LE or proctectomy were compared. 1:1 propensity score matching including patient demographics, clinical and therapeutic factors was used to minimize selection bias. Main outcome was overall survival (OS).

Results: 11,256 of 318,548 patients were included, 526 (4.6%) of whom underwent LE. After matching, mean 5-year OS was similar between the groups (54.1 vs. 54.2 months; p = 0.881). Positive resection margins (1.2% vs. 0.6%; p = 0.45), pathologic T stage (p = 0.07), 30-day mortality (0.6% vs. 0.6%; p = 1), and 90-day mortality (1.5% vs. 1.2%; p = 0.75) were comparable between the groups. Length of stay (1 vs. 6 days; p < 0.001) and 30-day readmission rate (5.3% vs. 10.3%; p = 0.02) were lower in LE patients. Multivariate analysis of predictors of OS demonstrated male sex (HR 1.38, 95% CI 1.08-1.77; p = 0.009), higher Charlson score (HR 1.52, 95% CI 1.29-1.79; p < 0.001), poorly differentiated carcinoma (HR 1.61, 95% CI 1.08-2.39; p = 0.02), mucinous carcinoma (HR 3.53, 95% CI 1.72-7.24; p < 0.001), and pathological T1 (HR 1.45, 95% CI 1.14-1.84; p = 0.002) were independent predictors of increased mortality. LE did not correlate with worse OS (HR 0.91, 95% CI 0.42-1.97; p = 0.82).

Conclusion: Our findings show no overall significant survival difference between LE and total mesorectal excision, including ypT1 tumors. Moreover, patients with poorly differentiated or mucinous adenocarcinomas generally had poorer outcomes, regardless of surgical method.

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新辅助治疗后 ypT0-1 直肠癌患者的局部切除术与直肠切除术：全国癌症数据库的倾向评分匹配分析。

背景：我们旨在评估直肠癌新辅助治疗后通过局部切除术（LE）与直肠切除术保留器官的效果：我们旨在评估直肠癌新辅助治疗后通过局部切除术（LE）保留器官与直肠切除术相比的效果：这项使用美国国家癌症数据库（NCDB）进行的回顾性观察研究纳入了2004年至2019年期间接受新辅助治疗的局部晚期非转移性直肠癌（ypT0-1肿瘤）患者。比较了接受LE或直肠切除术患者的预后。采用1:1倾向评分匹配，包括患者人口统计学、临床和治疗因素，以尽量减少选择偏倚。主要结果为总生存期（OS）：318548名患者中有11256名接受了LE治疗，其中526人（4.6%）接受了LE治疗。匹配后，两组患者的平均 5 年生存期相似（54.1 个月 vs. 54.2 个月；P = 0.881）。两组患者的切除边缘阳性率（1.2% 对 0.6%；p = 0.45）、病理 T 分期（p = 0.07）、30 天死亡率（0.6% 对 0.6%；p = 1）和 90 天死亡率（1.5% 对 1.2%；p = 0.75）相当。住院时间（1 天 vs. 6 天；p 结论：我们的研究结果表明，LE 和全直肠系膜切除术（包括 ypT1 肿瘤）的总体生存率没有明显差异。此外，无论采用哪种手术方法，分化不良或粘液腺癌患者的预后普遍较差。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.