Objectives: To explore the long-term outcome and prognostic factors for early stage rectal cancer patients undergoing standard resection (SR) or local excision (LE).
Patients and methods: This study included 350 patients with stage I rectal cancer, in which 283 cases (80.9%) received SR, and 67 cases (19.1%) received LE. Survival analyses were performed to compare outcomes of different surgeries.
Results: The 5-year local recurrence (LR) rate was 14.1% in LE group versus 3.3% in SR group (P= .0004), and the 10-year overall survival (OS) rate was not significantly different between the 2 groups. Multivariate analysis suggested that LE was an independent risk factor for 5-year LR rate and 10-year OS rate. Tumor grade was found related to 5-year LR, and T stage was found related to 10-year OS. Tumor size of 2.5 cm is found as a possible cut-off for predicting 5-year LR rate in LE group, with a sensitivity of 77.8% and a specificity of 75.9%. In patients with LE, the 5-year LR rate for tumors ≥ 2.5 cm was 40%, compared with 4.3% for tumors < 2.5 cm (P = .001).
Conclusion: Local excision in early-stage rectal cancer may result in high local recurrence rate. The procedure is only recommended in highly selective groups of patients. A tumor size of 2.5 cm is a useful criterion for choosing LE rather than SR.