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Objective:

Determine rates of local excision (LE) over time, and test the hypothesis that LE carries increased oncologic risks but reduced perioperative morbidity when compared with standard resection (SR).

Summary Background Data:

Despite the lack of level I/level II evidence supporting its oncologic adequacy, LE is performed for stage I rectal cancer.

Methods:

Surgical therapy for 35,179 patients with stage I rectal cancer diagnosed in 1989 to 2003 was examined over time, utilizing the National Cancer Database. A special study then analyzed perioperative outcomes, local recurrence and survival in 2124 patients diagnosed between 1994 and 1996, including 765 (T1, 601; T2, 164) treated by LE and 1359 (T1, 493; T2, 866) treated by SR.

Results:

From 1989 to 2003, the use of LE has increased (T1, 26.6–43.7%; T2, 5.8–16.8%; P< 0.001 both). The special study demonstrated significantly lower 30-day morbidity …