Local Resection Compared With Radical Resection in the Treatment of T1N0M0 Rectal Adenocarcinoma
- 1 January 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Diseases of the Colon & Rectum
- Vol. 58 (1), 122-140
- https://doi.org/10.1097/dcr.0000000000000293
Abstract
Local resection for early rectal cancer is thought to be less invasive but oncologically inferior to radical resection.The aim of this study was to compare local with radical resection in terms of oncologic control (survival and local recurrence), postoperative complications, and the need for a permanent stoma in adult patients with T1N0M0 rectal adenocarcinoma.Data were retrieved from Medline, Embase, Central, www.clinicaltrials.gov, and conference proceedings.Two reviewers independently screened studies and assessed the risk of bias.Local resection (transanal procedures, excluding endoscopic polypectomy) versus radical resection were considered.The primary outcomes measured were overall survival, major postoperative complications, and the 'need for permanent stoma.': One randomized controlled trial and 12 observational studies contributed 2855 patients for analysis. The randomized controlled trial was inadequately powered. Observational study meta-analysis showed that local resection was associated with significantly lower 5-year overall survival (72 more deaths per 1000 patients; 95%CI 30-120). However, the transanal endoscopic microsurgery subgroup did not yield significantly lower overall survival than radical resection. Local resection was associated with higher local recurrence but with lower perioperative mortality (relative risk 0.31, 95% CI 0.14-0.71), major postoperative complications (relative risk 0.20, 95% CI 0.10-0.41), and need for a permanent stoma (relative risk 0.17, 95% CI 0.09-0.30). Findings were robust to sensitivity analyses. Meta-regression suggests that the higher overall survival associated with radical resection may be explained by increased use of local resection on tumors in the lower third of the rectum, which have poorer prognosis.This systematic review of nonrandomized studies had inherent biases that may persist despite our rigorous use of systematic review methodology and sensitivity analyses.Local resection does not offer oncologic control comparable to radical surgery. However, this finding may be driven by the higher prevalence of cancers with poorer prognosis in local resection groups. Local resection is associated with lower postoperative complications, mortality, and the need for a permanent stoma. Local resection with transanal endoscopic microsurgery appears to offer oncologic control similar to that of radical resection while offering all the benefits of local resection.Keywords
This publication has 22 references indexed in Scilit:
- Survival Outcome of Local Excision versus Radical Resection of Colon or Rectal CarcinomaAnnals of Surgery, 2013
- Long-Term Survival After Transanal Excision of T1 Rectal CancerDiseases of the Colon & Rectum, 2009
- Is the increasing role of Transanal Endoscopic Microsurgery in curation for T1 rectal cancer justified? A systematic reviewActa Oncologica, 2009
- Local excision and endoscopic posterior mesorectal resection versus low anterior resection in T1 rectal cancerBritish Journal of Surgery, 2008
- Practical methods for incorporating summary time-to-event data into meta-analysisTrials, 2007
- Is the Increasing Rate of Local Excision for Stage I Rectal Cancer in the United States Justified?Annals of Surgery, 2007
- Endoscopic Posterior Mesorectal Resection After Transanal Local Excision of T1 Carcinomas of the Lower Third of the RectumDiseases of the Colon & Rectum, 2006
- The value of endosonographic rectal carcinoma staging in routine diagnostics: a 10-year analysisSurgical Endoscopy, 2004
- Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancerSurgical Endoscopy, 2003
- Male sexual function after autonomic nerve-preserving operation for rectal cancerDiseases of the Colon & Rectum, 1996