1. There was no significant difference in cancer-specific survival between local tumor excision and major resection of rectal and colon carcinoma in situ, or in T1 rectal cancer.
2. Local excision of T1-2 colon and T2 rectal cancer, when compared to major resection, was associated with reduced cancer-specific survival.
Evidence Rating Level: 2 (Good)
Study Rundown: Though major resection provides high oncological clearance, the risk of postoperative morbidity and mortality must be considered. This study of local excisions and major resections in colon and rectal cancer patients demonstrated that excision, specifically in T1-2 colon and T2 rectal cancer, led to reduced cancer-specific survival. Using the SEER database, the authors were able to analyze a large number of both excisions and resections. However, it is important to note that, because this was a non-randomized population based study, there appeared to be increased comorbidity in the local excision study population.
In-Depth [retrospective cohort]: This study compared the survival rates in 7378 local excisions and 36,116 major resections of colon and rectal cancer. The data was taken from the Surveillance, Epidemiology, and End Results (SEER) program, which collected data from regions representing 28% of the US population. The primary endpoint was 5 year cancer specific survival and the secondary endpoint was 5 year overall survival. Cancer specific survival in local excision, when compared to resection, for carcinoma in situ and T1 rectal cancer was not significantly different. Local excision of T1-2 colon cancer and T2 rectal cancer showed reduced cancer-specific survival (P = 0.020 for T1 colon, P < 0.001 for T2 colon, and P < 0.001 for T2 rectal).
By Amir Tarsha and Allen Ho
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