Local Excision vs. Radical Resection in T1-2 Rectal Carcinoma: Results of a Study From the Surveillance, Epidemiology, and End Results (SEER) Registry Data.

Background: Local excision (LE) has been used in an attempt to preserve anal function in T1-2 rectal carcinoma. The current study compares LE to radical resection (RR), each with or without radiation therapy (RT).
Methods: Patients reported to the SEER registry of the National Cancer Institute from 1988 to 2003 who had T1-2N0M0 rectal carcinoma were identified. A retrospective analysis of survival was performed using the Kaplan-Meier method. Comparative risks of mortality were evaluated using multivariate adjusted Cox regression models.
Results: Of 4,320 patients, 13% underwent LE alone, 7% underwent LE plus RT, 70% underwent RR alone, and 10% underwent RR plus RT. On multivariate analysis, patients who underwent LE without RT had inferior overall survival compared to patients who underwent RR (P < .05). Patients who underwent LE with or without RT had inferior cause-specific survival compared to patients who underwent RR (P < .05).
Conclusions: RR without RT was associated with superior overall survival compared to LE without RT, and RR without RT was associated with superior cause-specific survival compared to LE with or without RT. Randomized trials are necessary to determine if LE with or without RT can offer equivalent survival compared to RR in early stage rectal carcinoma.