Long-term results of local excision for XXXX .

@entity1 @entity5 @entity204 @entity420 @entity1487
OBJECTIVE: To review the authors' experience with local excision of early @entity5 to assess the effectiveness of initial treatment and of salvage surgery. SUMMARY BACKGROUND DATA: Local excision for @entity5 is appealing for its low morbidity and excellent functional results. However, its use is limited by inability to assess regional lymph nodes and uncertainty of oncologic outcome. METHODS: @entity1 with T1 and T2 @entity420 of the rectum treated by local excision as definitive surgery between 1969 to 1996 at the authors' institution were reviewed. Pathology slides were reviewed. Among 125 assessable @entity1 , 74 were T1 and 51 were T2. Thirty-one @entity1 (25%) were selected to receive adjuvant radiation therapy. Fifteen of these 31 @entity1 received adjuvant radiation in combination with @entity1487 chemotherapy. Median follow-up was 6.7 years. One hundred fifteen @entity1 (92%) were followed until @entity204 or for greater than 5 years, and 69 @entity1 (55%) were followed until @entity204 or for greater than 10 years. Recurrence was recorded as local, distant, and overall. Survival was disease-specific. RESULTS: Ten-year local recurrence and survival rates were 17% and 74% for T1 @entity5 and 26% and 72% for T2 @entity5 . Median time to relapse was 1.4 years (range 0.4-7.0) for local recurrence and 2.5 years (0.8-7.5) for distant recurrence. In @entity1 receiving radiotherapy, local recurrence was delayed (median 2.1 years vs. 1.1 years), but overall rates of local and overall recurrence and survival rates were similar to @entity1 not receiving radiotherapy. Among 26 @entity5 deaths, 8 (28%) occurred more than 5 years after local excision. On multivariate analysis, no clinical or pathologic features were predictive of local recurrence. Intratumoral vascular invasion was the only significant predictor of survival. Among 34 @entity1 who developed @entity5 recurrence, the pattern of first clinical recurrence was predominantly local: 50% local only, 18% local and distant, and 32% distant only. Among the 17 @entity1 with isolated local recurrence, 14 underwent salvage resection. Actuarial survival among these surgically salvaged @entity1 was 30% at 6 years after salvage. CONCLUSIONS The long-term risk of recurrence after local excision of T1 and T2 @entity5 is substantial. Two thirds of @entity1 with @entity5 recurrence have local failure, implicating inadequate resection in treatment failure. In this study, neither adjuvant radiotherapy nor salvage surgery was reliable in preventing or controlling local recurrence. The postoperative interval to @entity5 @entity204 is as long as 10 years, raising concern that @entity5 mortality may be higher than is generally appreciated. Additional treatment strategies are needed to improve the outcome of local excision.
