Transanal excision or radical surgery—which is the best treatment for T1 rectal cancer?

Successful surgical salvage after transanal excision (TAE) of rectal cancers has historically been considered feasible, but results vary. We examine our experience in surgical salvage of locally recurrent rectal cancers after TAE. A retrospective review of patients undergoing salvage surgery for locally recurrent early-stage rectal cancer after TAE from March 1990 to March 2008 at our institution is presented here. Seventy-eight patients underwent TAE for tumor invades submucosa (T1) rectal cancer. Average age of patients was 68.3 years. Recurrence occurred in 17 patients (21.8%). Median number of months between the first operation and the recurrence was 41 months. Sixteen out of 17 patients recurred locally whereas one had only distant recurrence. Fourteen were eligible for surgical salvage. Ten patients underwent abdominoperineal resection, whereas four underwent repeat local excision. Eleven deaths were noted and the median survival after the first operation was 70.3 months. Disease-free survival after salvage surgery was 53 per cent (9/17), with a median follow-up of 68 months from the original surgery. Disease-specific mortality was 47 per cent (8/17), with a median survival of 72 months from the original surgery. Five-year survival in the recurrence group was 11/16 (69%). In conclusion, TAE for T1 rectal cancer carries a higher risk of recurrence. Of the local recurrences, 87.5 per cent underwent microscopic negative margins (R0) resection at the time of salvage and had a five-year survival of 69 per cent. Long-term surveillance is encouraged, as recurrence can be seen even after 10 years from initial treatment. TAE can be considered for T1 rectal tumor with reasonable outcomes.

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Early Rectal Cancer: Transanal Excision or Radical Surgery?

Advances in Surgery ◽

10.1016/j.yasu.2006.06.008 ◽

2006 ◽

Vol 40 ◽

pp. 239-248 ◽

Cited By ~ 2

Author(s):

Kamran Idrees ◽

Philip B. Paty

Keyword(s):

Rectal Cancer ◽

Radical Surgery ◽

Transanal Excision ◽

Early Rectal Cancer

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National Disparities in Surgical Approach to T1 Rectal Cancer and Impact on Outcomes

The American Surgeon ◽

10.1177/000313481608201123 ◽

2016 ◽

Vol 82 (11) ◽

pp. 1080-1091 ◽

Cited By ~ 1

Author(s):

Emmanuel Gabriel ◽

Pragatheeshwar Thirunavukarasu ◽

Eisar Al-Sukhni ◽

Kristopher Attwood ◽

Steven J. Nurkin

Keyword(s):

Rectal Cancer ◽

Length Of Stay ◽

Local Excision ◽

Surgical Approach ◽

Radical Surgery ◽

Private Insurance ◽

Unplanned Readmission ◽

Cancer Data ◽

T1 Rectal Cancer ◽

Postoperative Length

This study investigated disparities between patients who had local excision versus radical resection for T1 rectal cancer. A retrospective analysis was performed using the National Cancer Data Base, 2004 to 2011. Inclusion criteria consisted of patients with T1, N0 rectal adenocarcinoma that were <3 cm, well or moderately differentiated without perineural invasion. Patients were stratified based on local excision and radical surgery. The primary outcome was overall survival (OS). Secondary outcomes included 30-day mortality, unplanned readmission rates, and postoperative length of stay. A total of 2235 patients were identified; 1335 (59.7%) underwent local excision and 900 (40.3%) had radical surgery. Overall, radical surgery was associated with an improved 5-year OS rate compared to local excision (0.86 vs 0.78, P = 0.009), increased unplanned readmission (6.5% vs 2.7%, P < 0.001), and longer postoperative length of stay (6.9 days vs 3.1 days, P < 0.001). For patients who had local excision, insurance status was an independent predictor of OS. Compared to patients with private insurance, those with government plans or no insurance had poorer OS (hazard ratio = 1.77 and 17.45, respectively, P = 0.006). Further study is warranted to understand the reasons accounting for this disparity in surgical approach to T1 rectal cancer.

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