ArticleSurgical endoscopy2026
Transanal local excision reduces surgical burden without evidence of increased recurrence in lower rectal GIST: a multicenter inverse probability of treatment weighting analysis.
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.
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Abstract
backgroundLower rectal gastrointestinal stromal tumors (rGISTs) pose a surgical challenge, as complete resection must be balanced against anorectal function preservation. Transanal local excision (taLE) may offer a less invasive alternative to transabdominal laparoscopic radical resection (tlRR), but comparative evidence, particularly for larger tumors, is limited.
methodsWe conducted a multicenter retrospective cohort study of patients with primary lower rGIST (lower tumor margin ≤ 5 cm from the anal verge; tumor size ≥ 2 cm and < 7 cm) undergoing taLE or tlRR (April 2015-April 2023). Inverse probability of treatment weighting (IPTW) balanced baseline characteristics, and doubly robust models adjusted residual imbalance. Perioperative outcomes, recurrence-free survival (RFS), and a prespecified ≥ 5 cm subgroup analysis were evaluated.
resultsAmong 101 patients (taLE, n = 74; tlRR, n = 27; median follow-up, 40 months), IPTW-adjusted analyses showed significantly reduced surgical burden with taLE: shorter operative time (- 118.4 min, P < 0.001), lower postoperative pain (- 2.5, P < 0.001), earlier drain removal (- 5.1 days, P = 0.008), no permanent stoma (0/74 vs. 5/27), and lower odds of temporary stoma (OR 0.05, P < 0.001) and reoperation (OR 0.02, P = 0.009). These advantages remained largely consistent in the ≥ 5 cm subgroup. Only four recurrences occurred, with no significant RFS difference (log-rank P = 0.43); power was limited.
conclusionstaLE was associated with substantially reduced surgical burden in selected patients with lower rGIST, and no significant difference in recurrence-free survival was observed during available follow-up. However, with only four events, the study was underpowered to establish oncologic equivalence. The taLE-based organ-preserving pathway may represent a promising option pending confirmation in larger cohorts.
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