TY - JOUR
T1 - Salvageable locoregional recurrence and stoma rate after local excision of pT1-2 rectal cancer
T2 - A nationwide cross-sectional cohort study
AU - Moolenaar, L. R.
AU - van Geffen, E. G.M.
AU - Hazen, S. J.A.
AU - Sluckin, T. C.
AU - Beets, Geerard L.
AU - Leijtens, J. W.A.
AU - Talsma, A. K.
AU - de Wilt, J. H.W.
AU - Tanis, P. J.
AU - Kusters, M.
AU - Hompes, R.
AU - Tuynman, J. B.
AU - Aalbers, Arend G.J.
AU - van Aalten, Susanna M.
AU - Amelung, Femke J.
AU - Ankersmit, Marjolein
AU - Antonisse, Imogeen E.
AU - Ashruf, Jesse F.
AU - Aukema, Tjeerd S.
AU - Avenarius, Henk
AU - Bahadoer, Renu R.
AU - Bakers, Frans C.H.
AU - Bakker, Ilsalien S.
AU - Bangert, Fleur
AU - Barendse, Renée M.
AU - Beekhuis, Heleen M.D.
AU - Beets, Geerard L.
AU - Beets-Tan, Regina G.H.
AU - Bemelman, Willem A.
AU - Berbée, Maaike
AU - de Bie, Shira H.
AU - Bisschops, Robert H.C.
AU - Blok, Robin D.
AU - van Bockel, Liselotte W.
AU - Braat, Manon N.G.J.A.
AU - Burghgraef, Thijs A.
AU - ten Cate, David W.G.
AU - Dekker, Jan Willem T.
AU - Goense, Lucas
AU - van Grevenstein, Wilhelmina M.U.
AU - den Hartogh, Mariska D.
AU - Hendriksen, Ellen M.
AU - van der Hoeven, Erik J.R.J.
AU - Intven, Martijn P.W.
AU - Ootes, Daan
AU - Plate, Joost D.J.
AU - Renger, Rutger Jan
AU - van Trier, Dorothée
AU - Verschuur, Anna V.D.
AU - Zandvoort, Herman J.A.
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025/6
Y1 - 2025/6
N2 - Background: Screening has increased the incidence of early-stage rectal cancer and interest in rectal-preserving treatment strategies. Although guidelines recommend completion total mesorectal excision (cTME) in the presence of histological risk factor(s) after local excision, surgery-related morbidity often deters patients from cTME. Additionally, locoregional recurrences (LR) identified during surveillance may still be salvageable. This study evaluates oncological and surgical outcomes in pT1-2 rectal cancer patients who received local excision with or without additional therapy. Methods: A retrospective cross-sectional national cohort study was conducted in 67 Dutch hospitals, including all patients who underwent curative surgical resection for rectal cancer in 2016. Patients with pT1-2 tumours who received surveillance, cTME or adjuvant chemoradiotherapy after local excision were selected. The primary outcome was LR. Secondary endpoints included ostomy rate, disease-free survival (DFS), and overall survival (OS). Results: Of 3057 patients, 219 underwent local excision, followed by surveillance in 74 % (n = 162), cTME in 23 % (n = 51), and adjuvant (chemo)radiation in 3 % (n = 6). Median follow-up was 46 months (IQR 29–54). Four-year LR rates were 14 % and 4 % after surveillance and cTME, respectively (p = 0.033). In the surveillance group, 16 of 20 patients (80 %) who developed LR were treated with curative intent. cTME resulted in a substantially higher ostomy rate (43 % vs 4 %, p = 0.001). No significant differences were found in 4-year DFS and OS. Conclusion: Despite a LR rate of 14 % after local excision alone, the majority of these recurrences could be treated with curative intent. Additionally, the risk of stoma was 10-fold lower after surveillance compared to cTME. Trial registration: ClinicalTrials.gov, identifier: NCT05539417, https://www.clinicaltrials.gov/ct2/show/NCT05539417.
AB - Background: Screening has increased the incidence of early-stage rectal cancer and interest in rectal-preserving treatment strategies. Although guidelines recommend completion total mesorectal excision (cTME) in the presence of histological risk factor(s) after local excision, surgery-related morbidity often deters patients from cTME. Additionally, locoregional recurrences (LR) identified during surveillance may still be salvageable. This study evaluates oncological and surgical outcomes in pT1-2 rectal cancer patients who received local excision with or without additional therapy. Methods: A retrospective cross-sectional national cohort study was conducted in 67 Dutch hospitals, including all patients who underwent curative surgical resection for rectal cancer in 2016. Patients with pT1-2 tumours who received surveillance, cTME or adjuvant chemoradiotherapy after local excision were selected. The primary outcome was LR. Secondary endpoints included ostomy rate, disease-free survival (DFS), and overall survival (OS). Results: Of 3057 patients, 219 underwent local excision, followed by surveillance in 74 % (n = 162), cTME in 23 % (n = 51), and adjuvant (chemo)radiation in 3 % (n = 6). Median follow-up was 46 months (IQR 29–54). Four-year LR rates were 14 % and 4 % after surveillance and cTME, respectively (p = 0.033). In the surveillance group, 16 of 20 patients (80 %) who developed LR were treated with curative intent. cTME resulted in a substantially higher ostomy rate (43 % vs 4 %, p = 0.001). No significant differences were found in 4-year DFS and OS. Conclusion: Despite a LR rate of 14 % after local excision alone, the majority of these recurrences could be treated with curative intent. Additionally, the risk of stoma was 10-fold lower after surveillance compared to cTME. Trial registration: ClinicalTrials.gov, identifier: NCT05539417, https://www.clinicaltrials.gov/ct2/show/NCT05539417.
KW - Completion TME
KW - Early rectal cancer
KW - Local excision
KW - Snapshot study
KW - Surveillance
UR - https://www.scopus.com/pages/publications/85217795968
U2 - 10.1016/j.ejso.2025.109623
DO - 10.1016/j.ejso.2025.109623
M3 - Article
AN - SCOPUS:85217795968
SN - 0748-7983
VL - 51
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 6
M1 - 109623
ER -