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Is Endoscopic Excision An Appropriate Treatment Modality In Patients Presenting With Early-Stage (cT1N0M0) Mid-Rectal Adenocarcinoma?
*Siena Roat-Shumway1, *Celsa Tonelli2, Fred A Luchette2, *Zaid Abdelsattar2, *Marc Singer2, Marshall S Baker2
1Loyola University Chicago, Stritch School of Medicine, Maywood, IL;2Loyola University Medical Center, Maywood, IL

Objective: Recent studies evaluating the efficacy of endoscopic resection (ER) in early stage rectal adenocarcinoma have primarily included low rectal cancers treated with abdominoperineal resection (APR) as control comparison cohorts. The role of ER in early stage rectal adenocarcinoma is incompletely defined. Methods: We queried the National Cancer Database to identify patients presenting with cT1N0M0 rectal adenocarcinoma between 2004 and 2016. Those undergoing APR were excluded. Multivariable logistic regression (MVR) was used to determine which factors associated with use of ER instead of low anterior resection (LAR). Patients undergoing ER were propensity score matched (PSM) for age, sex, race, insurance type, Charlson-Deyo comorbidity score (CDCC), tumor grade, tumor size, and year of diagnosis to those undergoing LAR. Rates of 5-year overall survival (OS) for matched-cohorts were compared using Kaplan Meier method. Results: 14,429 patients met inclusion criteria; 7,927 underwent ER and 6,502 underwent LAR. On univariate comparison, those undergoing ER had lower comorbidity scores (CDCC 0 score 79% vs 74%, p<0.001), were more likely to have well-differentiated tumors (32% vs 15%, p<0.001), and less likely to undergo treatment with adjuvant chemotherapy and radiotherapy (5% vs 22%; 6% vs 22%, respectively; p<0.001) than those undergoing LAR. On MVR, factors associated with use of ER included: advancing age (aOR 1.14, 95% CI [1.08, 1.20]), poorly differentiated histology (aOR 0.28, 95% CI [0.15, 0.44]), and tumor size>4 cm (aOR 0.15, 95% CI [0.13, 0.18]). 4,736 patients undergoing ER were successfully matched (1:1) to 4,736 patients undergoing LAR. On comparison of matched cohorts, those undergoing ER demonstrated lower rates of 30-day readmission (4% vs. 7%, p<0.001), mortality (0.5% vs 1%, p<0.001), and OS (79% vs 84%, p<0.0001), Figure 1) but higher rates of margin positive resection (10% vs 3%, all p<0.001) than LAR.
Conclusion: In patients presenting with cT1N0M0 rectal adenocarcinoma amenable to LAR, ER is associated with higher probability of margin positive resection but lower risk of postoperative morbidity and rates of overall survival comparable to segmental resection. .


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