title: Oncological outcome of T1 rectal cancer undergoing standard resection and local excision.
abstract: OBJECTIVE
  We studied the outcome and prognostic factors for T1 rectal cancer patients undergoing standard resection or transanal excision.
  
  
  METHODS
  One hundred and twenty-four patients with T1 rectal cancer were included in the study, of whom 66 (53.2%) underwent standard resection and 58 (46.8%) underwent transanal excision. Survival analysis was performed to compare the outcome.
  
  
  RESULTS
  The 5-year local recurrence rate was 11.0% in the transanal excision group versus 1.6% in the standard resection group (P = 0.031) but the 5-year disease-free survival and overall survival rates were not significantly different between the two groups. Multivariate analysis suggested that a high tumour grade and perineural or lymphovascular invasion were independent risk factors for local recurrence and recurrence-free survival. For high-risk patients (with at least one of the above risk factors), the 5-year local recurrence and 10-year recurrence-free survival rates were 21.2% and 74.5%, versus 1.2% and 92.0% in low-risk patients (P = 0.00003 and P = 0.003). In patients undergoing transanal excision, none in the low-risk group had local recurrence during follow up, while 40% (6 of 15) of patients in the high-risk group developed local recurrence within 5 years after surgery. The 5-year local recurrence rate was 45.0%.
  
  
  CONCLUSIONS
  Transanal excision in T1 rectal cancer may result in a high rate of local failure for patients with a high-grade tumour, or perineural or lymphovascular invasion. Local excision should be avoided as a curative treatment in high-risk patients.
authors.affiliation: Department of Colorectal Surgery, Cancer Hospital Fudan University, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: J
authors.initials: J
authors.lastname: Peng
authors.forename: W
authors.initials: W
authors.lastname: Chen
authors.forename: W
authors.initials: W
authors.lastname: Sheng
authors.forename: Y
authors.initials: Y
authors.lastname: Xu
authors.forename: G
authors.initials: G
authors.lastname: Cai
authors.forename: D
authors.initials: D
authors.lastname: Huang
authors.forename: S
authors.initials: S
authors.lastname: Cai
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome