Local excision for T1 rectal tumours: are we getting better?

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Rectal Cancer Treatment

Background:

• T1 rectal tumors represent an early stage of rectal cancer.
• Surgical management options include radical resection (RR) and local excision (LE).
• The choice of treatment can impact patient survival and surgical morbidity.

Purpose of the Study:

• To compare the overall survival (OS) rates of three surgical treatments for T1 rectal tumors: radical resection (RR), open local excision (open LE), and laparoscopic local excision (laparoscopic LE).
• To evaluate the trend in the utilization of LE versus RR over time.
• To assess the impact of different LE approaches (laparoscopic vs. open) and time periods on survival outcomes.

Main Methods:

• Analysis of adult patients diagnosed with T1 rectal cancer from the National Cancer Database (2008-2016).
• Stratification of patients by treatment type: LE versus RR.
• Subgroup analyses within the LE group based on time period (pre- and post-transanal minimally invasive surgery adoption) and surgical approach (laparoscopic vs. open).
• Primary outcome was 5-year overall survival (OS).

Main Results:

• Out of 10,053 patients, 65.88% underwent LE and 34.12% underwent RR.
• The utilization of LE increased significantly from 2008 to 2016, while RR decreased.
• No significant difference in 5-year OS was observed between LE and RR groups in both unadjusted and adjusted analyses.
• Laparoscopic LE showed a trend towards improved OS in unadjusted analysis compared to open LE, but this was not statistically significant in adjusted analysis.

Conclusions:

• Local excision (LE) is a viable surgical option for T1 rectal tumors, demonstrating comparable overall survival to radical resection (RR).
• The LE approach can potentially reduce surgical morbidity without compromising long-term survival.
• Findings support the consideration of LE as a treatment strategy for selected T1 rectal cancer patients.