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Local versus Radical Excision of Early Distal Rectal Cancers: A National Cancer Database Analysis

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Local excision (LE) has been proposed as an alternative to radical resection for early distal rectal cancer, for which the optimal oncologic treatment remains unclear.

Objective

The goal of this study was to compare the overall survival of rectal cancer patients with early distal tumors who underwent LE versus abdominoperineal resection (APR) using a large contemporary database.

Methods

The National Cancer Database (2004–2013) was used to identify patients with early T-stage rectal adenocarcinoma who underwent LE or APR. Patients were split into groups based on T stage and type of surgery (LE vs. APR). The primary outcome measure was overall survival. An adjusted Cox proportional hazards model was used to evaluate the impact of treatment strategy on survival.

Results

Overall, there were 2084 patients with T1 tumors and 912 patients with T2 tumors. For patients with T1 disease, after adjusting for age, sex, income level, race, Charlson score, insurance payor, and tumor size, there was no significant difference in survival between the LE and APR groups (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.65–1.22; P = 0.49). For patients with T2 disease, after adjusting for age, Charlson score, and tumor size, there was no significant difference in survival between patients undergoing LE + chemoradiation therapy (CRT) and APR (HR 1.11, 95% CI 0.84–1.45; P = 0.47).

Conclusions

Patients with early distal rectal adenocarcinoma who underwent LE had similar survival to patients who underwent APR. LE is an acceptable oncologic treatment strategy for patients with T1 rectal cancers, and LE with CRT is an acceptable oncologic treatment for patients with T2 distal rectal cancers.

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Acknowledgements

The authors declare no grant support or financial relationships.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Nelya Melnitchouk MD, MSc, Adam C. Fields MD, Pamela Lu MD, Rebecca E. Scully MD, MPH, Anathea C. Powell MD, Luisa Maldonado BS, Joel E. Goldberg MD, MPH & Ronald Bleday MD

Authors
  1. Nelya Melnitchouk MD, MSc
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  2. Adam C. Fields MD
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  3. Pamela Lu MD
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  4. Rebecca E. Scully MD, MPH
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  5. Anathea C. Powell MD
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  6. Luisa Maldonado BS
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  7. Joel E. Goldberg MD, MPH
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  8. Ronald Bleday MD
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Contributions

All authors made substantial contributions to the design of the work, drafted the work, provided final approval, and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Adam C. Fields MD.

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Disclosures

Nelya Melnitchouk, Adam C. Fields, Pamela Lu, Rebecca E. Scully, Anathea C. Powell, Luisa Maldonado, Joel E. Goldberg, and Ronald Bleday have no conflicts of interest to declare.

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Melnitchouk, N., Fields, A.C., Lu, P. et al. Local versus Radical Excision of Early Distal Rectal Cancers: A National Cancer Database Analysis. Ann Surg Oncol 27, 2169–2176 (2020). https://doi.org/10.1245/s10434-019-08155-4

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  • DOI: https://doi.org/10.1245/s10434-019-08155-4

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