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Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study

Received: 6 May 2019     Accepted: 6 June 2019     Published: 1 July 2019
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Abstract

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.

Published in Journal of Surgery (Volume 7, Issue 3)
DOI 10.11648/j.js.20190703.16
Page(s) 78-86
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Transanal Local Excision, Stage 1 Rectal Cancer, Total Mesorectal Excision

References
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[18] Gill S, Stetler JL, Patel A, et al. Transanal Minimally Invasive Surgery (TAMIS): Standardizing a Reproducible Procedure. J Gastrointest Surg 2015; 19: 1528-36.
[19] Guerrieri M, Gesuita R, Ghiselli R, et al. Treatment of rectal cancer by transanal endoscopic microsurgery: Experience with 425 patients. World Journal of Gastroenterology 2014; 20: 9556-63.
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Cite This Article
  • APA Style

    Crystal Koerner, Xi Sheng, Yuan Liu, Theresa Gillespie, Glen Balch, et al. (2019). 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, 7(3), 78-86. https://doi.org/10.11648/j.js.20190703.16

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    ACS Style

    Crystal Koerner; Xi Sheng; Yuan Liu; Theresa Gillespie; Glen Balch, et al. Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study. J. Surg. 2019, 7(3), 78-86. doi: 10.11648/j.js.20190703.16

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    AMA Style

    Crystal Koerner, Xi Sheng, Yuan Liu, Theresa Gillespie, Glen Balch, et al. Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study. J Surg. 2019;7(3):78-86. doi: 10.11648/j.js.20190703.16

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  • @article{10.11648/j.js.20190703.16,
      author = {Crystal Koerner and Xi Sheng and Yuan Liu and Theresa Gillespie and Glen Balch and Virginia Shaffer and Charles Staley and Jhanavi Srinivasan and Patrick Sullivan},
      title = {Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study},
      journal = {Journal of Surgery},
      volume = {7},
      number = {3},
      pages = {78-86},
      doi = {10.11648/j.js.20190703.16},
      url = {https://doi.org/10.11648/j.js.20190703.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20190703.16},
      abstract = {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  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.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study
    AU  - Crystal Koerner
    AU  - Xi Sheng
    AU  - Yuan Liu
    AU  - Theresa Gillespie
    AU  - Glen Balch
    AU  - Virginia Shaffer
    AU  - Charles Staley
    AU  - Jhanavi Srinivasan
    AU  - Patrick Sullivan
    Y1  - 2019/07/01
    PY  - 2019
    N1  - https://doi.org/10.11648/j.js.20190703.16
    DO  - 10.11648/j.js.20190703.16
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 78
    EP  - 86
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20190703.16
    AB  - 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  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.
    VL  - 7
    IS  - 3
    ER  - 

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Author Information
  • Department of Surgery, Emory University School of Medicine, Atlanta, USA

  • Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA

  • Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA

  • Department of Hematology & Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, USA

  • Division of Colon and Rectal Surgery, Emory University School of Medicine, Atlanta, USA

  • Division of Colon and Rectal Surgery, Emory University School of Medicine, Atlanta, USA

  • Division of Surgical Oncology, Emory University School of Medicine, Atlanta, USA

  • Division of Colon and Rectal Surgery, Emory University School of Medicine, Atlanta, USA

  • Division of Colon and Rectal Surgery, Emory University School of Medicine, Atlanta, USA

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