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Local Excision Of Colon Or Rectal Carcinoma Is Associated With Adverse Survival Compared With Radical Resection: A Surveillance, Epidemiology, And End Results (SEER) Population-based Study
Aneel Bhangu*, Gina Brown*, John Nicholls*, John Wong, Ara Darzi*, Paris Tekkis*
Royal Marsden Hospital, London, United Kingdom

Objective: Technological advances have enabled endoscopic and local excision techniques to be applied in the treatment of early colorectal cancer in preference to radical resectional surgery. The present study aimed to compare the cancer specific results of local excision with major resection.
Method: Patients with stage 0 (carcinoma-in-situ) or stage I (T1/2 N0 M0) adenocarcinoma of the colon or rectum undergoing surgery between 1998 and 2009 from 13 SEER regions were included. SEER uses the best available clinical, radiological and/or pathological data to assign stage. Local excision (endoscopic or surgical) was compared with major surgical resection using adjusted hazard ratios (HR) for 5-year overall survival (OS) and cancer specific survival (CSS).
Results: This study included 7378 (18.0%) local excisions and 36,116 (83.0%) major resections. There were 3553 (8.2%) patients with carcinoma-in-situ and 39,941 (91.8%) with a clinical stage I cancer. After adjusting for confounding factors, local tumor excision for carcinoma-in-situ was associated with HRs for 5-year OS and CSS of 1.05 (p=0.543) and 0.97 (p=0.865) compared with major resection. Local excision for early invasive carcinoma (clinically stage I) was associated with a worse 5-year OS and CSS compared with major resection (HR 1.35, p<0.001 and 1.14, p=0.043).
Conclusion: Local excision for early colorectal cancer is oncologically equivalent to major surgery for carcinoma-in-situ but inferior for early invasive (stage I) carcinoma.
StageLocal excisionMajor resectionLog-rank P
Stage 0 (Carcinoma-in-situ)5-year OS76.3%77.6%0.510
5-year CSS96.0%96.0%0.960
Stage I Invasive Carcinoma5-year OS68.4%75.2%<0.001
5-year CSS92.4%94.3%<0.001


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