ArticleAnnals of surgery2007
Is the increasing rate of local excision for stage I rectal cancer in the United States justified?: a nationwide cohort study from the National Cancer Database.
Article in Annals of surgery, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 108 papers, 9 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
108 citing papers in PubMed, 9 syntheses or guidelines pooled it, 319 citations in OpenAlex.
- Endoscopic and trans-anal local excision vs. radical resection in the treatment of early rectal cancer: A systematic review and network meta-analysis.International journal of colorectal disease · 2023Pooled it
- Robot-assisted TAMIS: a systematic review of feasibility and outcomes.Surgical endoscopy · 2023Pooled it
- Towards personalized treatment of T2N0 rectal cancer: A systematic review of long-term oncological outcomes of neoadjuvant therapy followed by local excision.Journal of gastroenterology and hepatology · 2022Pooled it
- Local recurrence after local excision of early rectal cancer: a meta-analysis of completion TME, adjuvant (chemo)radiation, or no additional treatment.The British journal of surgery · 2020Pooled it
- Executive Summary of the American Radium Society Appropriate Use Criteria for Local Excision in Rectal Cancer.International journal of radiation oncology, biology, physics · 2019Guideline
- Sentinel lymph node mapping procedure in T1 colorectal cancer: A systematic review of published studies.Medicine · 2019Pooled it
- Rectal Cancer, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology.Journal of the National Comprehensive Cancer Network : JNCCN · 2018Guideline
- Colonoscopy Surveillance after Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer.The American journal of gastroenterology · 2016Guideline
- Meta-analysis of histopathological features of primary colorectal cancers that predict lymph node metastases.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2012Pooled it
- Neoadjuvant Chemotherapy, Excision, and Observation for Early Rectal Cancer: The Phase II NEO Trial (CCTG CO.28) Primary End Point Results.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2023Trial
- Early and late morbidity of local excision after chemoradiotherapy for rectal cancer.BJS open · 2021Trial
- Long-term Oncological and Functional Outcomes of Chemoradiotherapy Followed by Organ-Sparing Transanal Endoscopic Microsurgery for Distal Rectal Cancer: The CARTS Study.JAMA surgery · 2019Trial
- Can weBMJ open · 2017Trial
- Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial.The Lancet. Oncology · 2015Trial
- A multi-center study of using carbon nanoparticles to track lymph node metastasis in T1-2 colorectal cancer.Surgical endoscopy · 2014Trial
- The CARTS study: Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery.BMC surgery · 2011Trial
- Transanal endoscopic microsurgery for rectal cancer. Long-term oncologic results.International journal of colorectal disease · 2011Trial
- Stepwise organ-preserving management of incidental pT1 rectal adenocarcinoma: outcomes after completion transanal endoscopic microsurgery (TEM).Surgical endoscopy · 2026Article
- International expert Delphi consensus on management of early and locally advanced rectal cancer.International journal of colorectal disease · 2025Article
- Predictive model for sphincter preservation in lower rectal cancer.World journal of clinical oncology · 2025Article
48 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
Abstract
objectiveDetermine 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.
methodsSurgical 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.
resultsFrom 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 after LE versus SR (5.6% vs. 14.6%; P < 0.001). After adjusting for patient and tumor characteristics, the 5-year local recurrence after LE versus SR was 12.5 versus 6.9% (P = 0.003; hazard ratio = 0.38; 95% CI, 0.23-0.62) for T1 tumors, and 22.1 versus 15.1% (P = 0.01; hazard ratio = 0.69; 95% CI, 0.44-1.07) for T2 tumors. The 5-year overall survival (T1, 77.4% vs. 81.7%, P = 0.09; T2, 67.6% vs. 76.5%, P = 0.01) was influenced by age and comorbidities but not the type of surgery.
conclusionsThis study provides the best evidence for both the increasing use and the associated risks of LE versus SR. For each individual patient, the benefits of LE must be balanced against the heightened risk of local failure.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.