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Oncological Outcome of Local vs Radical Resection of Low-Risk pT1 Rectal Cancer
Henry Ptok, MD;
Frank Marusch, PhD;
Frank Meyer, PhD;
Daniel Schubert, MD;
Ferdinand Koeckerling, PhD;
Ingo Gastinger, PhD;
Hans Lippert, PhD; for the Colon/Rectal Cancer (Primary Tumor) Study Group
Arch Surg. 2007;142(7):649-654.
Hypothesis 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.
Design 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.
Setting Two hundred eighty-two hospitals of all categories.
Patients Four hundred seventy-nine patients with low-risk pT1 rectal cancer treated for cure.
Interventions 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.
Main Outcome Measures 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.
Conclusion 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.
Author Affiliations: Institute for Quality Control in Operative Medicine (Drs Ptok, Marusch, Gastinger, and Lippert) and Department of General, Visceral, and Vascular Surgery (Drs Ptok, Meyer, Schubert, and Lippert), Otto-von-Guericke University Magdeburg, Magdeburg, Germany; Department of Surgery, Carl-Thiem Hospital Cottbus, Cottbus, Germany (Drs Ptok, Marusch, and Gastinger); and Department of Surgery, Hanover-Hospital, Hanover, Germany (Dr Koeckerling).
RELATED ARTICLE
Oncological Outcome of Local vs Radical Resection of Low-Risk pT1 Rectal Cancer—Invited Critique
James Church
Arch Surg. 2007;142(7):656.
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