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Primary local excision of stage 1 rectal cancer is not associated with worse oncological outcomes when compared with major resection

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Primary local excision (PLE) for early rectal cancers is associated with decreased surgical morbidity and mortality compared with major resection (MR). However, it is thought to be associated with poorer oncological outcomes. There is a paucity of data regarding PLE within the Australasian population. We present comparative post-operative and survival outcomes for stage 1 rectal cancers treated with PLE or MR from three Western Australian hospitals.

Methods

A retrospective analysis was performed on a prospectively maintained database of patients undergoing PLE or MR for stage 1 rectal cancers between February 1996 and May 2019.

Results

Of the 533 patients, 81 underwent PLE. Median post-operative admission was shorter for those undergoing PLE, with no significant difference in post-operative complication rate. Five-year overall survival was greater following MR (89.6% CI 86.1–92.3) compared with PLE (84.6% CI 73.8–91.2; p = 0.0003). There was no significant difference in 5-year cancer-specific survival (MR, 94.4% CI 91.5–96.3; PLE, 95.3% CI 86.0–98.5; p = 0.98) or 5-year disease-free survival (MR, 92.3% CI 89.1–94.7; PLE, 89.1% CI 78.5–94.7; p = 0.36). Local excision provided poorer local tumour control with an inferior 5-year local recurrence rate (MR, 2.16% CI 1.08–4.28; PLE, 10.9% CI 5.30–21.6; p = 0.0002). After controlling for confounders, PLE was significantly associated with worse local recurrence but did not significantly impact overall survival, cancer-specific survival, overall recurrence, or metastatic recurrence.

Conclusion

Local excision of early rectal cancer remains a viable alternative, in those unwilling or unable to undergo MR. Patients should be informed that while PLE is associated with poorer local pelvic control, this does not translate to worse survival.

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Acknowledgements

The authors would like to thank Richard Trevithick of the Western Australian Cancer Registry for his assistance in providing mortality data and death coding for the project.

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Authors and Affiliations

  1. St John of God Subiaco Hospital, Perth, Australia

    Ryan Cohen & Cameron Platell

  2. School of Medicine, The University of Notre Dame, Fremantle, Australia

    Ryan Cohen

  3. School of Surgery, University of Western Australia, Perth, Western Australia, Australia

    Cameron Platell

  4. Colorectal Research Unit, St John of God Subiaco Hospital, Perth, Western Australia, Australia

    Cameron Platell

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  1. Ryan Cohen
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Correspondence to Ryan Cohen.

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Cohen, R., Platell, C. Primary local excision of stage 1 rectal cancer is not associated with worse oncological outcomes when compared with major resection. Int J Colorectal Dis 35, 607–614 (2020). https://doi.org/10.1007/s00384-020-03512-2

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