T1 adenocarcinoma of the rectum

Transanal excision or radical surgery?

David J. Bentrem, Satoshi Okabe, W. Douglas Wong, Jose G. Guillem, Martin R. Weiser, Larissa K. Temple, Leah S. Ben-Porat, Bruce D. Minsky, Alfred M. Cohen, Philip B. Paty, David A. Rothenberger, Harold J. Wanebo, Merril T. Dayton, William W. Turner

Research output: Contribution to journalArticle

177 Citations (Scopus)

Abstract

Background: Recent studies suggest local excision may be acceptable treatment of T1 adenocarcinoma of the rectum, but there is little comparative data with radical surgery to assess outcomes and quantify risk. We performed a retrospective evaluation of patients with T1 rectal cancers treated by either transanal excision or radical resection at our institution to assess patient selection, cancer recurrence, and survival. Methods: All patients who underwent surgery for T1 adenocarcinomas of the rectum (0-15 cm from anal verge) by either transanal excision (TAE) or radical resection (RAD) between January 1987 and January 2004 were identified from a prospective database. Data were analyzed using Fisher exact test, Kaplan-Meier method, and log-rank test. Results: Three hundred nineteen consecutive patients with T1 lesions were treated by transanal excision (n = 151) or radical surgery (n = 168) over the 17-year period. RAD surgery was associated with higher tumor location in the rectum, slightly larger tumor size, a similar rate of adverse histology, and a lymph node metastasis rate of 18%. Despite these features, patients who underwent RAD surgery had fewer local recurrences, fewer distant recurrences, and significantly better recurrence-free survival (P = 0.0001). Overall and disease-specific survival was similar for RAD and TAE groups. Conclusion: Despite a similar risk profile in the 2 surgical groups, patients with T1 rectal cancer treated by local excision were observed to have a 3- to 5-fold higher risk of tumor recurrence compared with patients treated by radical surgery. Local excision should be reserved for low-risk cancers in patients who will accept an increased risk of tumor recurrence, prolonged surveillance, and possible need for aggressive salvage surgery. Radical resection is the more definitive surgical treatment of TI rectal cancers.

Original languageEnglish (US)
Pages (from-to)472-479
Number of pages8
JournalAnnals of Surgery
Volume242
Issue number4
DOIs
StatePublished - Oct 2005

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Rectum
Adenocarcinoma
Recurrence
Rectal Neoplasms
Neoplasms
Survival
Kaplan-Meier Estimate
Patient Selection
Histology
Lymph Nodes
Databases
Neoplasm Metastasis
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Bentrem, D. J., Okabe, S., Wong, W. D., Guillem, J. G., Weiser, M. R., Temple, L. K., ... Turner, W. W. (2005). T1 adenocarcinoma of the rectum: Transanal excision or radical surgery? Annals of Surgery, 242(4), 472-479. https://doi.org/10.1097/01.sla.0000183355.94322.db

T1 adenocarcinoma of the rectum : Transanal excision or radical surgery? / Bentrem, David J.; Okabe, Satoshi; Wong, W. Douglas; Guillem, Jose G.; Weiser, Martin R.; Temple, Larissa K.; Ben-Porat, Leah S.; Minsky, Bruce D.; Cohen, Alfred M.; Paty, Philip B.; Rothenberger, David A.; Wanebo, Harold J.; Dayton, Merril T.; Turner, William W.

In: Annals of Surgery, Vol. 242, No. 4, 10.2005, p. 472-479.

Research output: Contribution to journalArticle

Bentrem, DJ, Okabe, S, Wong, WD, Guillem, JG, Weiser, MR, Temple, LK, Ben-Porat, LS, Minsky, BD, Cohen, AM, Paty, PB, Rothenberger, DA, Wanebo, HJ, Dayton, MT & Turner, WW 2005, 'T1 adenocarcinoma of the rectum: Transanal excision or radical surgery?', Annals of Surgery, vol. 242, no. 4, pp. 472-479. https://doi.org/10.1097/01.sla.0000183355.94322.db
Bentrem DJ, Okabe S, Wong WD, Guillem JG, Weiser MR, Temple LK et al. T1 adenocarcinoma of the rectum: Transanal excision or radical surgery? Annals of Surgery. 2005 Oct;242(4):472-479. https://doi.org/10.1097/01.sla.0000183355.94322.db
Bentrem, David J. ; Okabe, Satoshi ; Wong, W. Douglas ; Guillem, Jose G. ; Weiser, Martin R. ; Temple, Larissa K. ; Ben-Porat, Leah S. ; Minsky, Bruce D. ; Cohen, Alfred M. ; Paty, Philip B. ; Rothenberger, David A. ; Wanebo, Harold J. ; Dayton, Merril T. ; Turner, William W. / T1 adenocarcinoma of the rectum : Transanal excision or radical surgery?. In: Annals of Surgery. 2005 ; Vol. 242, No. 4. pp. 472-479.
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abstract = "Background: Recent studies suggest local excision may be acceptable treatment of T1 adenocarcinoma of the rectum, but there is little comparative data with radical surgery to assess outcomes and quantify risk. We performed a retrospective evaluation of patients with T1 rectal cancers treated by either transanal excision or radical resection at our institution to assess patient selection, cancer recurrence, and survival. Methods: All patients who underwent surgery for T1 adenocarcinomas of the rectum (0-15 cm from anal verge) by either transanal excision (TAE) or radical resection (RAD) between January 1987 and January 2004 were identified from a prospective database. Data were analyzed using Fisher exact test, Kaplan-Meier method, and log-rank test. Results: Three hundred nineteen consecutive patients with T1 lesions were treated by transanal excision (n = 151) or radical surgery (n = 168) over the 17-year period. RAD surgery was associated with higher tumor location in the rectum, slightly larger tumor size, a similar rate of adverse histology, and a lymph node metastasis rate of 18{\%}. Despite these features, patients who underwent RAD surgery had fewer local recurrences, fewer distant recurrences, and significantly better recurrence-free survival (P = 0.0001). Overall and disease-specific survival was similar for RAD and TAE groups. Conclusion: Despite a similar risk profile in the 2 surgical groups, patients with T1 rectal cancer treated by local excision were observed to have a 3- to 5-fold higher risk of tumor recurrence compared with patients treated by radical surgery. Local excision should be reserved for low-risk cancers in patients who will accept an increased risk of tumor recurrence, prolonged surveillance, and possible need for aggressive salvage surgery. Radical resection is the more definitive surgical treatment of TI rectal cancers.",
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T1 - T1 adenocarcinoma of the rectum

T2 - Transanal excision or radical surgery?

AU - Bentrem, David J.

AU - Okabe, Satoshi

AU - Wong, W. Douglas

AU - Guillem, Jose G.

AU - Weiser, Martin R.

AU - Temple, Larissa K.

AU - Ben-Porat, Leah S.

AU - Minsky, Bruce D.

AU - Cohen, Alfred M.

AU - Paty, Philip B.

AU - Rothenberger, David A.

AU - Wanebo, Harold J.

AU - Dayton, Merril T.

AU - Turner, William W.

PY - 2005/10

Y1 - 2005/10

N2 - Background: Recent studies suggest local excision may be acceptable treatment of T1 adenocarcinoma of the rectum, but there is little comparative data with radical surgery to assess outcomes and quantify risk. We performed a retrospective evaluation of patients with T1 rectal cancers treated by either transanal excision or radical resection at our institution to assess patient selection, cancer recurrence, and survival. Methods: All patients who underwent surgery for T1 adenocarcinomas of the rectum (0-15 cm from anal verge) by either transanal excision (TAE) or radical resection (RAD) between January 1987 and January 2004 were identified from a prospective database. Data were analyzed using Fisher exact test, Kaplan-Meier method, and log-rank test. Results: Three hundred nineteen consecutive patients with T1 lesions were treated by transanal excision (n = 151) or radical surgery (n = 168) over the 17-year period. RAD surgery was associated with higher tumor location in the rectum, slightly larger tumor size, a similar rate of adverse histology, and a lymph node metastasis rate of 18%. Despite these features, patients who underwent RAD surgery had fewer local recurrences, fewer distant recurrences, and significantly better recurrence-free survival (P = 0.0001). Overall and disease-specific survival was similar for RAD and TAE groups. Conclusion: Despite a similar risk profile in the 2 surgical groups, patients with T1 rectal cancer treated by local excision were observed to have a 3- to 5-fold higher risk of tumor recurrence compared with patients treated by radical surgery. Local excision should be reserved for low-risk cancers in patients who will accept an increased risk of tumor recurrence, prolonged surveillance, and possible need for aggressive salvage surgery. Radical resection is the more definitive surgical treatment of TI rectal cancers.

AB - Background: Recent studies suggest local excision may be acceptable treatment of T1 adenocarcinoma of the rectum, but there is little comparative data with radical surgery to assess outcomes and quantify risk. We performed a retrospective evaluation of patients with T1 rectal cancers treated by either transanal excision or radical resection at our institution to assess patient selection, cancer recurrence, and survival. Methods: All patients who underwent surgery for T1 adenocarcinomas of the rectum (0-15 cm from anal verge) by either transanal excision (TAE) or radical resection (RAD) between January 1987 and January 2004 were identified from a prospective database. Data were analyzed using Fisher exact test, Kaplan-Meier method, and log-rank test. Results: Three hundred nineteen consecutive patients with T1 lesions were treated by transanal excision (n = 151) or radical surgery (n = 168) over the 17-year period. RAD surgery was associated with higher tumor location in the rectum, slightly larger tumor size, a similar rate of adverse histology, and a lymph node metastasis rate of 18%. Despite these features, patients who underwent RAD surgery had fewer local recurrences, fewer distant recurrences, and significantly better recurrence-free survival (P = 0.0001). Overall and disease-specific survival was similar for RAD and TAE groups. Conclusion: Despite a similar risk profile in the 2 surgical groups, patients with T1 rectal cancer treated by local excision were observed to have a 3- to 5-fold higher risk of tumor recurrence compared with patients treated by radical surgery. Local excision should be reserved for low-risk cancers in patients who will accept an increased risk of tumor recurrence, prolonged surveillance, and possible need for aggressive salvage surgery. Radical resection is the more definitive surgical treatment of TI rectal cancers.

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