Pathologic upstaging after definitive transanal endoscopic surgery for cT1N0M0 rectal cancer: patterns of care and survival.
Pathologic upstaging after transanal endoscopic surgery for early rectal cancer linked to higher mortality
Pathologic upstaging after definitive transanal endoscopic surgery for cT1N0M0 rectal cancer: patterns of care and survival.
Transanal endoscopic surgery (transanal endoscopic surgery) is an organ-preserving option for select patients with clinically T1N0M0 rectal adenocarcinoma that offers potential avoidance of total mesorectal excision (total mesorectal excision).
This study aims to quantify pathologic upstaging among patients who receive definitive transanal endoscopic surgery, identify associated clinicopathologic factors, evaluate overall survival, and compare outcomes between upstaged transanal endoscopic surgery versus total mesorectal excision patients.
Who received neoadjuvant therapy were excluded.
upstaging raised death risk versus no upstaging
Of 1,175 cT1N0M0 patients who underwent transanal endoscopic surgery, 101 (8.6%) were upstaged, predominately via tumor upstaging (86.1%).
Worse tumor differentiation (OR 2.15; CI 1.06-4.35) and larger tumors (> 3 cm OR 7.55; CI 3.24-17.58) were associated with upstaging.
Among patients upstaged after transanal endoscopic surgery, 38.6% received adjuvant therapy, with poorer tumor differentiation as the only factor differing from those who did not receive it.
8.6% of patients who undergo transanal endoscopic surgery-alone for cT1N0M0 rectal cancer were upstaged and experienced worse survival than appropriately-staged transanal endoscopic surgery and upstaged total mesorectal excision patients.
Careful patient selection, completion total mesorectal excision counseling, and improved staging accuracy have the potential to improve outcomes.