Are there survival differences between radical resection and local excision?

The authors aimed to evaluate the difference in survival outcomes between major surgical resection and local excision in early-stage colorectal cancer.

High-quality cancer clearance can be achieved by major surgical resection (removal of the tumor) in early-stage colorectal cancer, but this must be balanced against the risk of death and disease states after surgery. This type of surgery can be associated with a poor functional outcome or anostomatic leak (leaking of fluids from the point where the intestines are re-connected following removal of the tumor).  Technological advances have, however, allowed the application of local excision techniques, which allow removal of a smaller portion of tissue. However, there are concerns about the rate of failure (remaining cancer cells) for this technique.

The aim of this study was to compare the survival outcomes from local excision to major resection from stage 0 (very early stage) and stage I (early stage) cancer of the colon and rectum.

This study included 7,378 local excisions and 36,116 major resections for 30,232 colon and 13,262 patients with rectal cancer. The study assessed cancer-specific survival (length of time patients have not died from cancer in a specific time-frame).

Local excision of was associated with 31% increased risk of cancer-specific death in T1 (cancer is beginning to spread into the muscle layer of the colon) colon cancer and 2.89 times the risk of cancer-specific death in T2 (cancer has spread further into the muscle layer) colon cancer. There was also a 56% higher risk of reduced overall survival for T1 colon cancer and 2.41 times the risk of reduced overall survival for T2 colon cancer compared to radical resection.

Local excision was associated with a 16% increased risk of cancer-specific death in T1 rectal cancer but this was not deemed to be statistically significant. However, local excision was associated with a significant 71% increased risk of cancer-specific death in T2 rectal cancer. There was also a 29% higher risk of reduced overall survival for T1 rectal cancer and 71% increased risk for reduced overall survival in T2 rectal cancer.

There were no differences between those undergoing radical resection and local excision in stage 0 colorectal cancer.

The authors concluded that selection criteria such as stage and location of colorectal cancer should be considered when identifying patients who are likely to benefit from local excision versus radical resection.