ArticleSurgical endoscopy2026
Pathologic upstaging after definitive transanal endoscopic surgery for cT1N0M0 rectal cancer: patterns of care and survival.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTransanal endoscopic surgery (TES) is an organ-preserving option for select patients with clinically T1N0M0 rectal adenocarcinoma that offers potential avoidance of total mesorectal excision (TME). Preoperative staging is imperfect at distinguishing tumor stage and assessing nodal status, leaving the potential for pathologic upstaging after surgery. Oncologic implications for upstaged individuals who do not undergo completion TME are poorly characterized. This study aims to quantify pathologic upstaging among patients who receive definitive TES, identify associated clinicopathologic factors, evaluate overall survival, and compare outcomes between upstaged TES versus TME patients.
methodsNational Cancer Database (2010-2022) was used to identify cT1N0M0 rectal adenocarcinoma patients who underwent TES. Patients who received neoadjuvant therapy were excluded. Upstaging was defined as ≥ pT2 and/or ≥ pN1. A sub-analysis was conducted comparing upstaged patients for whom TES was the definitive procedure versus upstaged patients who underwent TME. Multivariable logistic regression identified associations with upstaging; Cox regression assessed overall survival.
resultsOf 1,175 cT1N0M0 patients who underwent TES, 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 TES, 38.6% received adjuvant therapy, with poorer tumor differentiation as the only factor differing from those who did not receive it. Upstaged patients had higher mortality than non-upstaged patients (HR 1.50; 95% CI 1.01-2.22). Compared to 2,350 upstaged cT1N0M0 patients who underwent TME, TES-only patients tended to be older, male, have smaller tumors and worse survival than TME patients (HR 1.54; 95% CI 1.07-2.22; p = 0.02).
conclusion8.6% of patients who undergo TES-alone for cT1N0M0 rectal cancer were upstaged and experienced worse survival than appropriately-staged TES and upstaged TME patients. Careful patient selection, completion TME counseling, and improved staging accuracy have the potential to improve outcomes.
Indexed as
Identifiers
42521832What OpenQuestion holds
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.