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Leijtens JWA, Smits LJH, Koedam TWA, Orsini RG, van Aalten SM, Verseveld M, Doornebosch PG, de Graaf EJR, Tuynman JB. Long-term oncological outcomes after local excision of T1 rectal cancer. Tech Coloproctol 2023; 27:23-33. [PMID: 36028782 PMCID: PMC9807482 DOI: 10.1007/s10151-022-02661-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/07/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND A growing proportion of patients with early rectal cancer is treated by local excision only. The aim of this study was to evaluate long-term oncological outcomes and the impact of local recurrence on overall survival for surgical local excision in pT1 rectal cancer. METHODS Patients who only underwent local excision for pT1 rectal cancer between 1997 and 2014 in two Dutch tertiary referral hospitals were included in this retrospective cohort study. The primary outcome was the local recurrence rate. Secondary outcomes were distant recurrence, overall survival and the impact of local recurrence on overall survival. RESULTS A total of 150 patients (mean age 68.5 ± 10.7 years, 57.3% males) were included in the study. Median length of follow-up was 58.9 months (range 6-176 months). Local recurrence occurred in 22.7% (n = 34) of the patients, with a median time to local recurrence of 11.1 months (range 2.3-82.6 months). The vast majority of local recurrences were located in the lumen. Five-year overall survival was 82.0%, and landmark analyses showed that local recurrence significantly impacted overall survival at 6 and 36 months of follow-up (6 months, p = 0.034, 36 months, p = 0.036). CONCLUSIONS Local recurrence rates after local excision of early rectal cancer can be substantial and may impact overall survival. Therefore, clinical decision-making should be based on patient- and tumour characteristics and should incorporate patient preferences.
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Affiliation(s)
- J. W. A. Leijtens
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands ,Department of Surgery, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
| | - L. J. H. Smits
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, The Netherlands ,Department of Surgery, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
| | - T. W. A. Koedam
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, The Netherlands ,Department of Surgery, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
| | - R. G. Orsini
- Department of Surgery, Elisabeth-Tweesteden Ziekenhuis, Tilburg, The Netherlands ,Department of Surgery, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
| | - S. M. van Aalten
- Department of Surgery, Groene Hart Ziekenhuis, Gouda, The Netherlands ,Department of Surgery, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
| | - M. Verseveld
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands ,Department of Surgery, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
| | - P. G. Doornebosch
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands ,Department of Surgery, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
| | - E. J. R. de Graaf
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands ,Department of Surgery, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
| | - J. B. Tuynman
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, The Netherlands ,Department of Surgery, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
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