Oncological outcome of local vs radical resection of low-risk pT1 rectal cancer.
OBJECTIVE
Despite the noninclusion of locally draining lymph nodes, limited resection of low-risk pT1 rectal cancer can achieve an adequate oncological outcome with lower morbidity and mortality compared with radical resection.


METHODS
Based on the data of a prospective multicenter observational study performed from January 1, 2000, through December 31, 2001, patients with low-risk pT1 rectal cancer underwent analysis with regard to the early postoperative outcome and the oncological long-term results achieved after limited vs radical resection with curative intent.


METHODS
Two hundred eighty-two hospitals of all categories.


METHODS
Four hundred seventy-nine patients with low-risk pT1 rectal cancer treated for cure.


METHODS
Eighty-five patients (17.7%) underwent limited excision using a conventional transanal approach and 35 (7.3%) using transanal endoscopic microsurgery. The remaining 359 (74.9%) underwent radical resection.


METHODS
Postoperative morbidity and mortality, local recurrence rate, and tumor-free and overall survival.


RESULTS
In comparison with radical resection, limited resection was associated with fewer general (25.1% vs 7.5%; P<.001) and specific (22.8% vs 9.2%; P<.001) postoperative complications. After a mean follow-up of 44 months, patients who underwent limited resection had a significantly higher 5-year local tumor recurrence rate than did those who underwent radical resection (6.0% vs 2.0%; P = .049), but tumor-free survival did not differ.


CONCLUSIONS
Limited resection of pT1 low-risk rectal cancer can result in an oncologically acceptable outcome but must nevertheless be considered an oncological compromise compared with radical resection.
Ptok
Henry
H
Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, D-39120 Magdeburg, Germany. henry.ptok@medizin.uni-magdeburg.de
Marusch
Frank
F
Meyer
Frank
F
Schubert
Daniel
D
Koeckerling
Ferdinand
F
Gastinger
Ingo
I
Lippert
Hans
H
D000368:Aged; D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome