Salvageable locoregional recurrence and stoma rate after local excision of pT1-2 rectal cancer - A nationwide cross-sectional cohort study

L. R. Moolenaar; E. G. M. van Geffen; S. J. A. Hazen; T. C. Sluckin; G. L. Beets; J. W. A. Leijtens; A. K. Talsma; J. H. W. de Wilt; P. J. Tanis; M. Kusters; R. Hompes; J. B. Tuynman

doi:10.1016/j.ejso.2025.109623

Salvageable locoregional recurrence and stoma rate after local excision of pT1-2 rectal cancer - A nationwide cross-sectional cohort study

L. R. Moolenaar, E. G. M. van Geffen, S. J. A. Hazen, T. C. Sluckin, G. L. Beets, J. W. A. Leijtens, A. K. Talsma, J. H. W. de Wilt, P. J. Tanis, M. Kusters, R. Hompes^*, J. B. Tuynman

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Screening has increased the incidence of early-stage rectal cancer and interest in rectal-preserving treatment strategies. Although guidelines recommend completion total mesorectal excision (cTME) in the presence of histological risk factor(s) after local excision, surgery-related morbidity often deters patients from cTME. Additionally, locoregional recurrences (LR) identified during surveillance may still be salvageable. This study evaluates oncological and surgical outcomes in pT1-2 rectal cancer patients who received local excision with or without additional therapy. Methods: A retrospective cross-sectional national cohort study was conducted in 67 Dutch hospitals, including all patients who underwent curative surgical resection for rectal cancer in 2016. Patients with pT1-2 tumours who received surveillance, cTME or adjuvant chemoradiotherapy after local excision were selected. The primary outcome was LR. Secondary endpoints included ostomy rate, disease-free survival (DFS), and overall survival (OS). Results: Of 3057 patients, 219 underwent local excision, followed by surveillance in 74 % (n = 162), cTME in 23 % (n = 51), and adjuvant (chemo)radiation in 3 % (n = 6). Median follow-up was 46 months (IQR 29-54). Fouryear LR rates were 14 % and 4 % after surveillance and cTME, respectively (p = 0.033). In the surveillance group, 16 of 20 patients (80 %) who developed LR were treated with curative intent. cTME resulted in a substantially higher ostomy rate (43 % vs 4 %, p = 0.001). No significant differences were found in 4-year DFS and OS. Conclusion: Despite a LR rate of 14 % after local excision alone, the majority of these recurrences could be treated with curative intent. Additionally, the risk of stoma was 10-fold lower after surveillance compared to cTME. Trial registration: ClinicalTrials.gov, identifier: NCT05539417, https://www.clinicaltrials.gov/ct2/show/NC T05539417.

Original language	English
Article number	109623
Number of pages	8
Journal	European Journal of Surgical Oncology
Volume	51
Issue number	6
Early online date	1 Feb 2025
DOIs	https://doi.org/10.1016/j.ejso.2025.109623
Publication status	E-pub ahead of print - 1 Feb 2025

Keywords

Early rectal cancer
Local excision
Surveillance
Completion TME
Snapshot study
TRANSANAL ENDOSCOPIC MICROSURGERY
SHORT-TERM OUTCOMES
RADICAL SURGERY
T1
CHEMORADIOTHERAPY
MANAGEMENT
RESECTION
TRIAL
GUIDELINES
SOCIETY

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Moolenaar, L. R., van Geffen, E. G. M., Hazen, S. J. A., Sluckin, T. C., Beets, G. L., Leijtens, J. W. A., Talsma, A. K., de Wilt, J. H. W., Tanis, P. J., Kusters, M., Hompes, R., & Tuynman, J. B. (2025). Salvageable locoregional recurrence and stoma rate after local excision of pT1-2 rectal cancer - A nationwide cross-sectional cohort study. European Journal of Surgical Oncology, 51(6), Article 109623. Advance online publication. https://doi.org/10.1016/j.ejso.2025.109623

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title = "Salvageable locoregional recurrence and stoma rate after local excision of pT1-2 rectal cancer - A nationwide cross-sectional cohort study",

abstract = "Background: Screening has increased the incidence of early-stage rectal cancer and interest in rectal-preserving treatment strategies. Although guidelines recommend completion total mesorectal excision (cTME) in the presence of histological risk factor(s) after local excision, surgery-related morbidity often deters patients from cTME. Additionally, locoregional recurrences (LR) identified during surveillance may still be salvageable. This study evaluates oncological and surgical outcomes in pT1-2 rectal cancer patients who received local excision with or without additional therapy. Methods: A retrospective cross-sectional national cohort study was conducted in 67 Dutch hospitals, including all patients who underwent curative surgical resection for rectal cancer in 2016. Patients with pT1-2 tumours who received surveillance, cTME or adjuvant chemoradiotherapy after local excision were selected. The primary outcome was LR. Secondary endpoints included ostomy rate, disease-free survival (DFS), and overall survival (OS). Results: Of 3057 patients, 219 underwent local excision, followed by surveillance in 74 % (n = 162), cTME in 23 % (n = 51), and adjuvant (chemo)radiation in 3 % (n = 6). Median follow-up was 46 months (IQR 29-54). Fouryear LR rates were 14 % and 4 % after surveillance and cTME, respectively (p = 0.033). In the surveillance group, 16 of 20 patients (80 %) who developed LR were treated with curative intent. cTME resulted in a substantially higher ostomy rate (43 % vs 4 %, p = 0.001). No significant differences were found in 4-year DFS and OS. Conclusion: Despite a LR rate of 14 % after local excision alone, the majority of these recurrences could be treated with curative intent. Additionally, the risk of stoma was 10-fold lower after surveillance compared to cTME. Trial registration: ClinicalTrials.gov, identifier: NCT05539417, https://www.clinicaltrials.gov/ct2/show/NC T05539417.",

keywords = "Early rectal cancer, Local excision, Surveillance, Completion TME, Snapshot study, TRANSANAL ENDOSCOPIC MICROSURGERY, SHORT-TERM OUTCOMES, RADICAL SURGERY, T1, CHEMORADIOTHERAPY, MANAGEMENT, RESECTION, TRIAL, GUIDELINES, SOCIETY",

author = "Moolenaar, {L. R.} and {van Geffen}, {E. G. M.} and Hazen, {S. J. A.} and Sluckin, {T. C.} and Beets, {G. L.} and Leijtens, {J. W. A.} and Talsma, {A. K.} and {de Wilt}, {J. H. W.} and Tanis, {P. J.} and M. Kusters and R. Hompes and Tuynman, {J. B.}",

year = "2025",

month = feb,

day = "1",

doi = "10.1016/j.ejso.2025.109623",

language = "English",

volume = "51",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "W.B. Saunders Ltd",

number = "6",

}

Moolenaar, LR, van Geffen, EGM, Hazen, SJA, Sluckin, TC, Beets, GL, Leijtens, JWA, Talsma, AK, de Wilt, JHW, Tanis, PJ, Kusters, M, Hompes, R & Tuynman, JB 2025, 'Salvageable locoregional recurrence and stoma rate after local excision of pT1-2 rectal cancer - A nationwide cross-sectional cohort study', European Journal of Surgical Oncology, vol. 51, no. 6, 109623. https://doi.org/10.1016/j.ejso.2025.109623

TY - JOUR

T1 - Salvageable locoregional recurrence and stoma rate after local excision of pT1-2 rectal cancer - A nationwide cross-sectional cohort study

AU - Moolenaar, L. R.

AU - van Geffen, E. G. M.

AU - Hazen, S. J. A.

AU - Sluckin, T. C.

AU - Beets, G. L.

AU - Leijtens, J. W. A.

AU - Talsma, A. K.

AU - de Wilt, J. H. W.

AU - Tanis, P. J.

AU - Kusters, M.

AU - Hompes, R.

AU - Tuynman, J. B.

PY - 2025/2/1

Y1 - 2025/2/1

N2 - Background: Screening has increased the incidence of early-stage rectal cancer and interest in rectal-preserving treatment strategies. Although guidelines recommend completion total mesorectal excision (cTME) in the presence of histological risk factor(s) after local excision, surgery-related morbidity often deters patients from cTME. Additionally, locoregional recurrences (LR) identified during surveillance may still be salvageable. This study evaluates oncological and surgical outcomes in pT1-2 rectal cancer patients who received local excision with or without additional therapy. Methods: A retrospective cross-sectional national cohort study was conducted in 67 Dutch hospitals, including all patients who underwent curative surgical resection for rectal cancer in 2016. Patients with pT1-2 tumours who received surveillance, cTME or adjuvant chemoradiotherapy after local excision were selected. The primary outcome was LR. Secondary endpoints included ostomy rate, disease-free survival (DFS), and overall survival (OS). Results: Of 3057 patients, 219 underwent local excision, followed by surveillance in 74 % (n = 162), cTME in 23 % (n = 51), and adjuvant (chemo)radiation in 3 % (n = 6). Median follow-up was 46 months (IQR 29-54). Fouryear LR rates were 14 % and 4 % after surveillance and cTME, respectively (p = 0.033). In the surveillance group, 16 of 20 patients (80 %) who developed LR were treated with curative intent. cTME resulted in a substantially higher ostomy rate (43 % vs 4 %, p = 0.001). No significant differences were found in 4-year DFS and OS. Conclusion: Despite a LR rate of 14 % after local excision alone, the majority of these recurrences could be treated with curative intent. Additionally, the risk of stoma was 10-fold lower after surveillance compared to cTME. Trial registration: ClinicalTrials.gov, identifier: NCT05539417, https://www.clinicaltrials.gov/ct2/show/NC T05539417.

AB - Background: Screening has increased the incidence of early-stage rectal cancer and interest in rectal-preserving treatment strategies. Although guidelines recommend completion total mesorectal excision (cTME) in the presence of histological risk factor(s) after local excision, surgery-related morbidity often deters patients from cTME. Additionally, locoregional recurrences (LR) identified during surveillance may still be salvageable. This study evaluates oncological and surgical outcomes in pT1-2 rectal cancer patients who received local excision with or without additional therapy. Methods: A retrospective cross-sectional national cohort study was conducted in 67 Dutch hospitals, including all patients who underwent curative surgical resection for rectal cancer in 2016. Patients with pT1-2 tumours who received surveillance, cTME or adjuvant chemoradiotherapy after local excision were selected. The primary outcome was LR. Secondary endpoints included ostomy rate, disease-free survival (DFS), and overall survival (OS). Results: Of 3057 patients, 219 underwent local excision, followed by surveillance in 74 % (n = 162), cTME in 23 % (n = 51), and adjuvant (chemo)radiation in 3 % (n = 6). Median follow-up was 46 months (IQR 29-54). Fouryear LR rates were 14 % and 4 % after surveillance and cTME, respectively (p = 0.033). In the surveillance group, 16 of 20 patients (80 %) who developed LR were treated with curative intent. cTME resulted in a substantially higher ostomy rate (43 % vs 4 %, p = 0.001). No significant differences were found in 4-year DFS and OS. Conclusion: Despite a LR rate of 14 % after local excision alone, the majority of these recurrences could be treated with curative intent. Additionally, the risk of stoma was 10-fold lower after surveillance compared to cTME. Trial registration: ClinicalTrials.gov, identifier: NCT05539417, https://www.clinicaltrials.gov/ct2/show/NC T05539417.

KW - Early rectal cancer

KW - Local excision

KW - Surveillance

KW - Completion TME

KW - Snapshot study

KW - TRANSANAL ENDOSCOPIC MICROSURGERY

KW - SHORT-TERM OUTCOMES

KW - RADICAL SURGERY

KW - T1

KW - CHEMORADIOTHERAPY

KW - MANAGEMENT

KW - RESECTION

KW - TRIAL

KW - GUIDELINES

KW - SOCIETY

U2 - 10.1016/j.ejso.2025.109623

DO - 10.1016/j.ejso.2025.109623

M3 - Article

SN - 0748-7983

VL - 51

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 6

M1 - 109623

ER -

Salvageable locoregional recurrence and stoma rate after local excision of pT1-2 rectal cancer - A nationwide cross-sectional cohort study

Abstract

Keywords

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