- Local excision is associated with worse outcomes compared with radical resection in early rectal cancer, but may be an option in T1 tumors with no pathologic features.
Why this matters
- Local excision has advantages with respect to morbidity and function, but patient selection remains an issue.
- Systematic review of 16 studies.
- Funding: None disclosed.
- 8 studies confirmed that patients undergoing local excision had fewer postoperative complications. The largest study (n=2124) showed a rate of 5.6% vs 14.6% (P<.001>
- 4 studies found that local excision was less likely to result in clear or negative margins.
- It was unclear if functional outcomes at 1 year were better with localized excision.
- 12 studies examined local recurrence rates and OS, and 6 showed higher recurrence rates with local excision.
- 2 studies showed no difference in local recurrence with local excision in T1 tumors, but a higher rate of recurrence in T2 tumors.
- 14 studies found a shorter OS associated with local excision, but the difference was statistically significant in only 5 studies. 1 study showed a difference in T2 tumors, but not T1.
- Most included studies were retrospective and none were randomized.