Oncological outcome of local vs radical resection of low-risk pT1 rectal cancer

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.