Comparative outcomes of organ-preserving surgery vs. radical resection for clinical T2N0 rectal cancer: A retrospective analysis.

BACKGROUND

Radical resection is recommended for clinical T2N0 rectal cancer, yet some patients receive local excision or neoadjuvant therapy, practices traditionally excluded from national guidelines for this stage. We aimed to assess treatment patterns and the impact of surgical approach and neoadjuvant therapy on overall survival.

METHODS

This was a retrospective cohort study utilizing the American College of Surgeons National Cancer Database. Patients diagnosed with clinical T2N0 rectal adenocarcinoma who underwent local excision or radical resection were included. The primary outcome was overall survival.

RESULTS

Of 11,513 patients, 1,853 (16.1%) underwent local excision and were older, more comorbid, and more likely to be female (all p < 0.001). Five-year survival was lower for local excision (65.4%) versus radical resection (77.2%), p < 0.001). This persisted across neoadjuvant therapy subgroups. Local excision was associated with worse survival (HR = 1.15, 95% CI: 1.06-1.25, p < 0.001). Neoadjuvant chemoradiation conferred increased hazard of death compared to no neoadjuvant therapy (HR = 1.20, 95% CI: 1.11-1.30, p < 0.001). Highest risk was observed in patients receiving both local excision and neoadjuvant chemoradiation (HR = 1.36, 95% CI: 1.13-1.63, p < 0.001).

CONCLUSIONS

Since 2006, local excision and neoadjuvant therapy have been used in a stable minority of patients with T2N0 disease. Recent guidelines have incorporated these treatment options. Data suggest worse overall survival associated with this minority group, highlighting the need for prospective studies to define optimal treatment strategies.