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Local excision in early rectal cancer-outcome worse than expected: a population based study
Division of Surgery, CLINTEC, Karolinska Institutet, Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Sweden.
Division of Surgery, CLINTEC, Karolinska Institutet, Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Sweden.
Division of Surgery, CLINTEC, Karolinska Institutet, Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Sweden.
2013 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 39, no 6, 634-639 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Considering the morbidity and mortality after abdominal surgery for rectal cancer, our aim was to determine whether local excision in Stage I rectal cancer provides long-term survival equivalent to TME surgery, particularly in elderly patients.

METHODS: Data on 3694 consecutive patients with Stage I rectal cancer operated 1995-2006, were collected from the Swedish Rectal Cancer Register, a population-based, prospectively sampled data-base. Risk factors for death within 5 years after surgery, local recurrence rates, cumulative relative and overall survival rates were calculated for patients ≥ and <80 years-of-age. ASA grading related to surgical technique was analysed in a separate sample.

RESULTS: Local excision (LE) was associated with an increased mortality risk both ≥80 (HR 1.55) and <80 years-of-age (HR 1.45). After LE the 5-year local recurrence rate was 11.2% and the total and relative cumulative 5-year survival was 0.62 and 0.81 respectively. Hartmann's procedure (HA) showed an increased mortality risk only in younger patients (HR 2.15). The overall local recurrence rate was 7.2% with HA. Male gender (HR 1.70) and age (HR 1.06) were associated with a significantly increased mortality risk in all age groups. The ASA-grade was higher among patients operated with LE compared to Anterior Resection/Abdominoperineal resection.

CONCLUSION: Local excision has a poor outcome in the elderly. A negative selection bias towards old age and high co-morbidity could explain this. Hartmann's procedure has a high risk for mortality and local recurrence in younger patients.

Place, publisher, year, edition, pages
2013. Vol. 39, no 6, 634-639 p.
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-83431DOI: 10.1016/j.ejso.2013.01.004PubMedID: 23414776OAI: oai:DiVA.org:umu-83431DiVA: diva2:667126
Available from: 2013-11-25 Created: 2013-11-25 Last updated: 2017-12-06Bibliographically approved

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