Local excision for T1 rectal cancer: A population-based study of practice patterns and oncological outcomes

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2025-01-10 DOI:10.1111/codi.17276

Kelly E. Brennan, Ameer O. Farooq, Tyler J. Mckechnie, Vanessa H. Wiseman, Weidong Kong, Clare R. Bankhead, Carl J. Heneghan, Mandip S. Rai, Sunil V. Patel

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Abstract

Aim

Local excision (LE) for T1 rectal cancer may be recommended in those with low-risk disease, while resection is typically recommended in those with a high risk of luminal recurrence or lymph node metastasis. The aim of this work was to compare survival between resection and LE.

Method

This was a population-based retrospective cohort study set in the Canadian province of Ontario. Patients were individuals with T1Nx rectal cancer between 2010 and 2014 and demographics, disease characteristics, treatments and outcomes were determined using linked administrative databases. This study does not include clinical information regarding individual patient treatment decisions. The main outcome measure was overall survival (OS).

Results

A total of 719 patients were identified, including 359 with upfront resection, 113 with LE and immediate resection (<90 days) and 247 with LE with definitive intent. The majority of LEs were performed via colonoscopy. Piecemeal excision (42% vs. 49%, p = 0.28) and positive margin (50% vs. 77%, p < 0.01) rates were high in both LE groups, with the highest rate in those with immediate resection. The prevalence of poor differentiation (<5%, p = 0.70) and lymphovascular invasion (LVI) (14%, p = 0.80) was similar across groups. In those with LE with definitive intent, 21% ultimately underwent resection (median 150 days, interquartile range 114–181 days) and 4% received radiation. There was no difference in 5-year OS between groups (resection 83.2% vs. LE and immediate resection 82.3% vs. definitive LE 83.3%; p = 0.33). Adjusted analyses demonstrated no association between approach and survival [definitive intent LE hazard ratio (HR) 0.97 (95% CI 0.70–1.35), LE and immediate resection HR 0.97 (95% CI 0.60–1.45), upfront resection HR 1 (Ref); p = 0.98]. Differentiation, piecemeal excisions and LVI were not associated with OS in the LE groups.

Conclusion

There were no observed differences in survival between those who underwent resection, LE and immediate resection and definitive intent LE. Although, these are observational data, they call into question the reflexive decision to offer radical resection for those with suspected T1 rectal cancer.

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T1期直肠癌局部切除：一项基于人群的实践模式和肿瘤学结果研究。

目的：T1期直肠癌的局部切除（LE）对于低风险的患者可能是推荐的，而对于腔内复发或淋巴结转移的高风险患者通常推荐切除。这项工作的目的是比较切除和LE之间的生存。方法：这是一项在加拿大安大略省进行的基于人群的回顾性队列研究。患者是2010年至2014年间患有T1Nx直肠癌的个体，使用相关的管理数据库确定人口统计学、疾病特征、治疗和结果。本研究不包括个别患者治疗决定的临床信息。主要结局指标为总生存期（OS）。结果：共确定719例患者，其中术前切除359例，LE +立即切除113例(结论：行切除、LE +立即切除和明确意图LE患者的生存率无明显差异。尽管这些都是观察性数据，但它们对为怀疑为T1期直肠癌的患者提供根治性切除的条件反射性决定提出了质疑。

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

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.