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NESS 2006 Annual Meeting
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Local Excision of Rectal Cancer: A Meta-Analysis
Jacob A Greenberg, Caprice C Greenberg, Stuart Lipsitz, Ronald Bleday
Brigham and Women's Hospital, Boston, MA

Objective: We hypothesized that local excision(LE) does not adversely affect overall survival(OS) when compared to radical resection for stage I rectal cancer.
Design: Meta-Analysis
Setting: University Hospitals
Patients: We analyzed 23 articles in PubMed, totaling 651 T1 tumors treated by LE alone and 314 T2 tumors treated by LE plus adjuvant therapy. As a control, we analyzed the SEER database for OS in stage I rectal cancer treated with abdomino-perineal resection(APR)(N=120 T1N0 and N=168 T2N0).
Interventions: None
Main Outcome Measures: 5-year rates of OS for LE and APR. Secondary outcome measures included 5-year rates of local recurrence(LR), distant metastases(DM), and disease-free survival(DFS) for LE.
Results: The OS was 82.9% for LE T1 versus 72.5% for APR T1(p=0.06) and 79.8% for LE T2 versus 69.0% for APR T2(p=0.10). LR for T1 and T2 lesions treated with LE were 10.7% and 15.0% respectively, while the rate of DM was 7.1% for T1 and 9.1% for T2. DFS for T1 and T2 were 79.4% and 73.4% respectively.
Conclusions: LE alone for T1 lesions and LE plus adjuvant therapy for T2 lesions showed no statistically significant difference in OS when compared to APR for stage I rectal cancer. While LE may have an increased rate of LR compared to APR, OS is not affected. Further, LR can likely be lowered with the use of endorectal imaging to guide patient selection.

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