Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study
Journal of Surgery
Volume 7, Issue 3, June 2019, Pages: 78-86
Received: May 6, 2019; Accepted: Jun. 6, 2019; Published: Jul. 1, 2019
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Crystal Koerner, Department of Surgery, Emory University School of Medicine, Atlanta, USA
Xi Sheng, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
Yuan Liu, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
Theresa Gillespie, Department of Hematology & Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, USA
Glen Balch, Division of Colon and Rectal Surgery, Emory University School of Medicine, Atlanta, USA
Virginia Shaffer, Division of Colon and Rectal Surgery, Emory University School of Medicine, Atlanta, USA
Charles Staley, Division of Surgical Oncology, Emory University School of Medicine, Atlanta, USA
Jhanavi Srinivasan, Division of Colon and Rectal Surgery, Emory University School of Medicine, Atlanta, USA
Patrick Sullivan, Division of Colon and Rectal Surgery, Emory University School of Medicine, Atlanta, USA
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Previous data from the National Cancer Database (NCBD) showed increasing rates of transanal local excision for early rectal cancer despite a lack of evidence supporting its oncologic adequacy. The aim of this study is to update national trends, compare overall survival, and determine factors associated with survival in patients with stage I rectal cancer. Survival of 15, 149 patients with stage I rectal adenocarcinoma were examined retrospectively from 2004-2012. The rate of local excision over this time period was sustained at 22% (20.88 - 24.9%; p = 0.077). Five-year overall survival (OS) after transanal local excision was less than transabdominal standard resection (76.6% vs. 80.7%; p < 0.0001). Lower 5-year OS for transanal local excision was maintained with propensity score matching (HR 1.23; CI (1.11-1.36; p < 0.001). Factors associated with decreased OS include positive margins, T2 tumors, tumors > 4 cm, low volume centers, uninsured patients and increasing comorbidities. This is the first study of national data showing sustained use of transanal local excision over the past decade. Local excision has a lower 5-year OS compared to transabdominal standard resection. Transanal excision of early rectal cancer should be offered to select patients only after careful consideration of risk factors balanced against the decrease in overall survival.
Transanal Local Excision, Stage 1 Rectal Cancer, Total Mesorectal Excision
To cite this article
Crystal Koerner, Xi Sheng, Yuan Liu, Theresa Gillespie, Glen Balch, Virginia Shaffer, Charles Staley, Jhanavi Srinivasan, Patrick Sullivan, Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study, Journal of Surgery. Vol. 7, No. 3, 2019, pp. 78-86. doi: 10.11648/j.js.20190703.16
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This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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