Gabriel Emmanuel, Thirunavukarasu Pragatheeshwar, Al-Sukhni Eisar, Attwood Kristopher, Nurkin Steven J
Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA.
Am Surg. 2016 Nov 1;82(11):1080-1091.
This study investigated disparities between patients who had local excision versus radical resection for T1 rectal cancer. A retrospective analysis was performed using the National Cancer Data Base, 2004 to 2011. Inclusion criteria consisted of patients with T1, N0 rectal adenocarcinoma that were <3 cm, well or moderately differentiated without perineural invasion. Patients were stratified based on local excision and radical surgery. The primary outcome was overall survival (OS). Secondary outcomes included 30-day mortality, unplanned readmission rates, and postoperative length of stay. A total of 2235 patients were identified; 1335 (59.7%) underwent local excision and 900 (40.3%) had radical surgery. Overall, radical surgery was associated with an improved 5-year OS rate compared to local excision (0.86 vs 0.78, P = 0.009), increased unplanned readmission (6.5% vs 2.7%, P < 0.001), and longer postoperative length of stay (6.9 days vs 3.1 days, P < 0.001). For patients who had local excision, insurance status was an independent predictor of OS. Compared to patients with private insurance, those with government plans or no insurance had poorer OS (hazard ratio = 1.77 and 17.45, respectively, P = 0.006). Further study is warranted to understand the reasons accounting for this disparity in surgical approach to T1 rectal cancer.
本研究调查了T1期直肠癌患者行局部切除与根治性切除之间的差异。利用国家癌症数据库进行了一项回顾性分析，时间跨度为2004年至2011年。纳入标准包括患有T1、N0期直肠腺癌且肿瘤直径<3 cm、高分化或中分化且无神经侵犯的患者。患者根据局部切除和根治性手术进行分层。主要结局是总生存期（OS）。次要结局包括30天死亡率、非计划再入院率和术后住院时间。共识别出2235例患者；1335例（59.7%）接受了局部切除，900例（40.3%）进行了根治性手术。总体而言，与局部切除相比，根治性手术与5年总生存率提高相关（0.86对0.78，P = 0.009），非计划再入院率增加（6.5%对2.7%，P < 0.001），术后住院时间更长（6.9天对3.1天，P < 0.001）。对于接受局部切除的患者，保险状况是总生存期的独立预测因素。与拥有私人保险的患者相比，拥有政府医保计划或无保险的患者总生存期较差（风险比分别为1.77和17.45，P = 0.006）。有必要进行进一步研究以了解T1期直肠癌手术方式存在这种差异的原因。
