*Department of Colorectal Surgery, Royal Marsden Hospital, Fulham Road, London, UK †Division of Surgery, Imperial College, Chelsea and Westminster Campus, London, UK ‡Department of Radiology, Royal Marsden Hospital, Fulham Road, London, UK §Division of Surgery, Imperial College, St Mary's Hospital, London, UK ¶Department of Surgery, University of Hong Kong medical Centre, Queen Mary Hospital, Hong Kong.
Ann Surg. 2013 Oct;258(4):563-9; discussion 569-71. doi: 10.1097/SLA.0b013e3182a4e85a.
To compare cancer-specific results of local excision with major resection.
Technological advances have enabled endoscopic and local excision techniques to be applied in the treatment of early colorectal cancer in preference to radical surgery.
Patients with stage 0 (carcinoma in situ) or stage I (T1/2N0M0) adenocarcinoma of the colon or rectum undergoing surgery between 1998 and 2009 were included from the SEER (Surveillance, Epidemiology, and End Results) database. Local excision (endoscopic or surgical) was compared with major surgical resection using adjusted hazard ratios (HRs) for 5-year cancer-specific survival (CSS).
This study included 7378 local excisions and 36,116 major resections. There were 3553 patients with carcinoma in situ and 39,941 with clinical stage I cancer. Local tumor excision for carcinoma in situ was associated with equivalent CSS compared to major resection (HRs = 1.06, P = 0.814, for colon and 0.78, P = 0.494, for rectum). Local excision of T1 and T2 colon cancer was associated with reduced CSS (HR = 1.31, P = 0.020, and 2.89, P < 0.001, respectively). Local excision of T1 rectal cancer did not affect CSS (HR = 1.16, P = 0.236), but it significantly reduced CSS for T2 cancer (HR = 1.71, P < 0.001). Subgroup analysis of T1 and T2 rectal cancer after neoadjuvant therapy and local excision showed oncological equivalence to major resection (HR = 1.12, P = 0.802, and 1.23, P = 0.802).
Local excision for early colorectal cancer was oncologically equivalent to major surgery for carcinoma in situ and T1 rectal cancer, but inferior for T1-2 colon and T2 rectal cancer. Exploratory data suggest local excision of T1-2 rectal cancer after neoadjuvant therapy may be safe.
比较局部切除与根治性切除术的癌症特异性结果。
技术进步使得内镜和局部切除技术能够应用于早期结直肠癌的治疗，而不是采用根治性手术。
从 SEER（监测、流行病学和最终结果）数据库中纳入 1998 年至 2009 年间接受手术治疗的 0 期（原位癌）或 I 期（T1/2N0M0）结直肠腺癌患者。使用 5 年癌症特异性生存率（CSS）的调整后的危险比（HRs）比较局部切除（内镜或手术）与根治性切除术。
本研究共纳入 7378 例局部切除术和 36116 例根治性切除术。其中 3553 例为原位癌患者，39941 例为临床 I 期癌症患者。局部肿瘤切除治疗原位癌与根治性切除术的 CSS 相当（HRs = 1.06，P = 0.814，结肠；0.78，P = 0.494，直肠）。T1 和 T2 结肠癌的局部切除与 CSS 降低相关（HR = 1.31，P = 0.020；2.89，P < 0.001）。T1 直肠癌的局部切除未影响 CSS（HR = 1.16，P = 0.236），但显著降低了 T2 期癌症的 CSS（HR = 1.71，P < 0.001）。新辅助治疗后 T1 和 T2 直肠癌的亚组分析显示，局部切除与根治性切除术的肿瘤学等效性（HR = 1.12，P = 0.802；1.23，P = 0.802）。
对于早期结直肠癌，局部切除在肿瘤学上与根治性手术相当，适用于原位癌和 T1 直肠癌，但对 T1-2 结肠癌和 T2 直肠癌则效果较差。探索性数据分析表明，新辅助治疗后 T1-2 直肠癌的局部切除可能是安全的。
