Previous data from the National Cancer Database (NCBD) showed increasing rates of transanal local excision for early rectal cancer despite a lack of evidence supporting its oncologic adequacy. The aim of this study is to update national trends, compare overall survival, and determine factors associated with survival in patients with stage I rectal cancer. Survival of 15, 149 patients with stage I rectal adenocarcinoma were examined retrospectively from 2004-2012. The rate of local excision over this time period was sustained at 22% (20.88 - 24.9%; p = 0.077). Five-year overall survival (OS) after transanal local excision was less than transabdominal standard resection (76.6% vs. 80.7%; p < 0.0001). Lower 5-year OS for transanal local excision was maintained with propensity score matching (HR 1.23; CI (1.11-1.36; p < 0.001). Factors associated with decreased OS include positive margins, T2 tumors, tumors > 4 cm, low volume centers, uninsured patients and increasing comorbidities. This is the first study of national data showing sustained use of transanal local excision over the past decade. Local excision has a lower 5-year OS compared to transabdominal standard resection. Transanal excision of early rectal cancer should be offered to select patients only after careful consideration of risk factors balanced against the decrease in overall survival.
| Published in | Journal of Surgery (Volume 7, Issue 3) |
| DOI | 10.11648/j.js.20190703.16 |
| Page(s) | 78-86 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2019. Published by Science Publishing Group |
Transanal Local Excision, Stage 1 Rectal Cancer, Total Mesorectal Excision
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APA Style
Crystal Koerner, Xi Sheng, Yuan Liu, Theresa Gillespie, Glen Balch, et al. (2019). Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study. Journal of Surgery, 7(3), 78-86. https://doi.org/10.11648/j.js.20190703.16
ACS Style
Crystal Koerner; Xi Sheng; Yuan Liu; Theresa Gillespie; Glen Balch, et al. Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study. J. Surg. 2019, 7(3), 78-86. doi: 10.11648/j.js.20190703.16
AMA Style
Crystal Koerner, Xi Sheng, Yuan Liu, Theresa Gillespie, Glen Balch, et al. Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study. J Surg. 2019;7(3):78-86. doi: 10.11648/j.js.20190703.16
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Download@article{10.11648/j.js.20190703.16,
author = {Crystal Koerner and Xi Sheng and Yuan Liu and Theresa Gillespie and Glen Balch and Virginia Shaffer and Charles Staley and Jhanavi Srinivasan and Patrick Sullivan},
title = {Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study},
journal = {Journal of Surgery},
volume = {7},
number = {3},
pages = {78-86},
doi = {10.11648/j.js.20190703.16},
url = {https://doi.org/10.11648/j.js.20190703.16},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20190703.16},
abstract = {Previous data from the National Cancer Database (NCBD) showed increasing rates of transanal local excision for early rectal cancer despite a lack of evidence supporting its oncologic adequacy. The aim of this study is to update national trends, compare overall survival, and determine factors associated with survival in patients with stage I rectal cancer. Survival of 15, 149 patients with stage I rectal adenocarcinoma were examined retrospectively from 2004-2012. The rate of local excision over this time period was sustained at 22% (20.88 - 24.9%; p = 0.077). Five-year overall survival (OS) after transanal local excision was less than transabdominal standard resection (76.6% vs. 80.7%; p 4 cm, low volume centers, uninsured patients and increasing comorbidities. This is the first study of national data showing sustained use of transanal local excision over the past decade. Local excision has a lower 5-year OS compared to transabdominal standard resection. Transanal excision of early rectal cancer should be offered to select patients only after careful consideration of risk factors balanced against the decrease in overall survival.},
year = {2019}
}
TY - JOUR T1 - Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study AU - Crystal Koerner AU - Xi Sheng AU - Yuan Liu AU - Theresa Gillespie AU - Glen Balch AU - Virginia Shaffer AU - Charles Staley AU - Jhanavi Srinivasan AU - Patrick Sullivan Y1 - 2019/07/01 PY - 2019 N1 - https://doi.org/10.11648/j.js.20190703.16 DO - 10.11648/j.js.20190703.16 T2 - Journal of Surgery JF - Journal of Surgery JO - Journal of Surgery SP - 78 EP - 86 PB - Science Publishing Group SN - 2330-0930 UR - https://doi.org/10.11648/j.js.20190703.16 AB - Previous data from the National Cancer Database (NCBD) showed increasing rates of transanal local excision for early rectal cancer despite a lack of evidence supporting its oncologic adequacy. The aim of this study is to update national trends, compare overall survival, and determine factors associated with survival in patients with stage I rectal cancer. Survival of 15, 149 patients with stage I rectal adenocarcinoma were examined retrospectively from 2004-2012. The rate of local excision over this time period was sustained at 22% (20.88 - 24.9%; p = 0.077). Five-year overall survival (OS) after transanal local excision was less than transabdominal standard resection (76.6% vs. 80.7%; p 4 cm, low volume centers, uninsured patients and increasing comorbidities. This is the first study of national data showing sustained use of transanal local excision over the past decade. Local excision has a lower 5-year OS compared to transabdominal standard resection. Transanal excision of early rectal cancer should be offered to select patients only after careful consideration of risk factors balanced against the decrease in overall survival. VL - 7 IS - 3 ER -
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