Survival Outcome of Local Excision versus Radical Resection of Colon or Rectal Carcinoma

Bhangu, Aneel; Brown, Gina; Nicholls, R. J.; Wong, John W.; Darzi, Ara; Tekkis, Paris

doi:10.1097/sla.0b013e3182a4e85a

Cited by 93 publications

(12 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…20 and Bhangu et al. 21 conducted two retrospective studies focusing on local excision versus radical resection for colorectal cancer in all ages based on SEER database. The former one suggested that local excision was associated with inferior CSS of T1 rectal cancer compared with radical resection.…”

Section: Discussionmentioning

confidence: 99%

Long‐term oncological outcomes of local excision versus radical resection for early colorectal cancer in young patients without preoperative chemoradiotherapy: a population‐based propensity matching study

et al. 2018

View full text Add to dashboard Cite

The incidence and mortality of colorectal carcinoma are rising in young adults. This population‐based propensity matching study aimed to compare long‐term oncological outcomes of local excision with radical resection for early localized colorectal cancer (CRC) in young patients without preoperative chemoradiotherapy. Patients under 45 years old with T1 colon or rectal adenocarcinoma who underwent local excision or radical resection were included from the Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2014. Survival curves were plotted using the Kaplan–Meier method. Cancer‐specific survival (CSS) was compared using adjusted hazard ratios (HRs) between local excision and radical resection. After propensity score matching procedure, total of 1719 patients were included in the analysis, among which 573 treated with local excision and 1146 treated with radical resection. The median follow‐up was 80 months (interquartile range(IQR): 37–132), with 1074 patients followed for ≥5 years and 508 patients followed for ≥10 years. Five‐year CSS of local excision versus radical resection was 93.4% versus 96.7% for colon cancer and 96.6% versus 98.4% for rectal cancer. Ten‐year CSS of local excision versus radical resection was 91.4% versus 94.0% for colon cancer and 92.8% versus 96.7% for rectal cancer. On multivariable analysis, compared with radical resection, local excision was not associated with inferior CSS for colon (HR 1.74, 95% CI: 0.92–3.29, P = 0.090) and rectal cancer (HR 2.16, 95% CI: 0.99–4.71, P = 0.052). There is no evidence of differential long‐term oncological outcomes between local excision and radical resection. These findings supported clinical application of local excision for early colon and rectal cancer in young adults.

show abstract

Section: Discussionmentioning

confidence: 99%

Long‐term oncological outcomes of local excision versus radical resection for early colorectal cancer in young patients without preoperative chemoradiotherapy: a population‐based propensity matching study

et al. 2018

View full text Add to dashboard Cite

show abstract

“…We, therefore, administered CRT in all patients with pT1 rectal cancer postoperatively. Some studies have found no difference between local excision and TME surgery in local recurrence rates or outcomes of patients with T1 rectal cancer [7, 14, 29]. However, Stornes et al [6] studied 543 patients with T1 rectal cancer and reported that the local recurrence rate was 14.5% in patients who underwent transanal endoscopic microsurgery, which was significantly higher than the recurrence rate (1.4%) in patients who underwent TME ( p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Local Excision plus Chemoradiotherapy in Patients with T1 Rectal Cancer

et al. 2018

View full text Add to dashboard Cite

Objective: The National Comprehensive Cancer Network (NCCN) guidelines recommend local excision and observation as standard treatment for selected patients with clinical T1N0M0 rectal cancer. In patients with pathological T1 (pT1) rectal cancer who received local excision, the local recurrence rate is at least 10%. We studied oncological outcomes in patients with pT1 rectal cancer who received chemoradiotherapy (CRT) after local excision. Methods: Local excision was performed in 65 patients with clinical T1N0M0 rectal cancer (≤8 cm from the anal verge, tumor size < 30 mm, well or moderately differentiated adenocarcinoma). The patients received CRT (40 or 45 Gy in 1.8–2.0 fractions with concurrent oral UFT [tegafur/uracil] or S-1 [tegafur/gimeracil/oteracil]) after confirmation of pT1 and negative margins. Results: Patients who had pT2 cancer or who did not provide informed consent were excluded. The remaining 50 patients additionally received CRT. The CRT was completed in 48 patients (96%). The median follow-up period was 71 months. Local recurrence occurred in 1 patient (2%). Distant metastases occurred in 3 patients (6%). The 5-year disease-free survival rate was 86%, and the 5-year overall survival rate was 92%. Conclusions: Our study suggested that multidisciplinary treatment with local excision plus CRT can be used as a treatment option in selected patients with clinical T1N0M0 rectal cancer.

show abstract

“…Although evidence is limited and well-designed clinical trials are required for cT1, sm1 tumors with low-risk features, standard transanal excision or excision by means of TEM, if technically feasible, is recommended as definitive treatment [ 154 , 155 ]. For cT1, sm2 tumors with low-risk features definitive treatment (TME) is the treatment of choice.…”

Section: Transabdominal Resection: Surgical Principlesmentioning

confidence: 99%

“…For cT1, sm2 tumors with low-risk features definitive treatment (TME) is the treatment of choice. Local excision is not recommended outside clinical trials, unless the patient refuses definitive treatment or has co-morbidities [ 154 , 155 ]. If histopathology shows deeper invasion or additional high-risk features (poor differentiation, lympho-vascular, venous or neural invasion) CRT can be added with or without definitive surgery.…”

Section: Transabdominal Resection: Surgical Principlesmentioning

confidence: 99%

Clinical practice guidelines for the surgical treatment of rectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO)

Xynos¹,

Tekkis

Gouvas

et al. 2016

aog

View full text Add to dashboard Cite

In rectal cancer management, accurate staging by magnetic resonance imaging, neo-adjuvant treatment with the use of radiotherapy, and total mesorectal excision have resulted in remarkable improvement in the oncological outcomes. However, there is substantial discrepancy in the therapeutic approach and failure to adhere to international guidelines among different Greek-Cypriot hospitals. The present guidelines aim to aid the multidisciplinary management of rectal cancer, considering both the local special characteristics of our healthcare system and the international relevant agreements (ESMO, EURECCA). Following background discussion and online communication sessions for feedback among the members of an executive team, a consensus rectal cancer management was obtained. Statements were subjected to the Delphi methodology voting system on two rounds to achieve further consensus by invited multidisciplinary international experts on colorectal cancer. Statements were considered of high, moderate or low consensus if they were voted by ≥80%, 60-80%, or <60%, respectively; those obtaining a low consensus level after both voting rounds were rejected. One hundred and two statements were developed and voted by 100 experts. The mean rate of abstention per statement was 12.5% (range: 2-45%). In the end of the process, all statements achieved a high consensus. Guidelines and algorithms of diagnosis and treatment were proposed. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized.

show abstract

Survival Outcome of Local Excision versus Radical Resection of Colon or Rectal Carcinoma

Abstract: Local excision for early colorectal cancer was oncologically equivalent to major surgery for carcinoma in situ and T1 rectal cancer, but inferior for T1-2 colon and T2 rectal cancer. Exploratory data suggest local excision of T1-2 rectal cancer after neoadjuvant therapy may be safe.

Cited by 93 publications

References 26 publications

Long‐term oncological outcomes of local excision versus radical resection for early colorectal cancer in young patients without preoperative chemoradiotherapy: a population‐based propensity matching study

Long‐term oncological outcomes of local excision versus radical resection for early colorectal cancer in young patients without preoperative chemoradiotherapy: a population‐based propensity matching study

Outcomes of Local Excision plus Chemoradiotherapy in Patients with T1 Rectal Cancer

Clinical practice guidelines for the surgical treatment of rectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO)

Contact Info

Product

Resources

About