title: T1 adenocarcinoma of the rectum: transanal excision or radical surgery?
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.
  
  
  CONCLUSIONS
  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 T1 rectal cancers.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okabe
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Wong
authors.forename: Jose G
authors.initials: JG
authors.lastname: Guillem
authors.forename: Martin R
authors.initials: MR
authors.lastname: Weiser
authors.forename: Larissa K
authors.initials: LK
authors.lastname: Temple
authors.forename: Leah S
authors.initials: LS
authors.lastname: Ben-Porat
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Minsky
authors.forename: Alfred M
authors.initials: AM
authors.lastname: Cohen
authors.forename: Philip B
authors.initials: PB
authors.lastname: Paty
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003113:Colonoscopy; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome