A Comparative Study On The Clinical Efficacy Of Local Excision And Radical Surgery In The Treatment Of T1N0M0 Rectal Cancer

Objective:To compare and analyze the clinical efficacy and safety of local excision and radical surgery for T1N0M0 rectal cancer.Methods:In this study,clinical data of patients who underwent surgical treatment and were determined to have stage T1 rectal cancer after postoperative histopathological examination at China-Japan Union Hospital of Jilin University between January 2016 and June 2020 were collected for retrospective analysis.Screening was performed through certain inclusion and exclusion criteria,and 76 patients who met the criteria were finally included in the study.The patients were divided into local resection group and radical surgery group according to different surgical methods.The local resection group included endoscopic mucosal resection（EMR）,endoscopic submucosal dissection（ESD）,and transanal excision（TAE）,a total of 24 cases;A total of 52 individuals who met the screening criteria had laparoscopic radical surgery for rectal cancer in the radical surgery group.The following patients’ general data and tumor information were statistically analyzed: age,gender,body mass index（BMI）,tumor size,tumor location,tumor differentiation,preoperative CEA level,preoperative CA19-9 level;the related data during surgery: average operation time;postoperative recovery of patients: postoperative bowel ventilation time,postoperative urinary catheter removal time,average postoperative hospitalization time;postoperative complications: postoperative bleeding,anal pain,anal incontinence,incisional infection,pulmonary infection,urinary tract infection,anastomotic fistula,anastomotic stricture,incisional hernia,etc.;comparison of anal or artificial stoma conditions;survival evaluation indexes: tumor recurrence rate,overall survival rate,and disease-free survival rate,etc.Results:1.There were no statistically significant differences in the general information of patients such as age,gender,BMI,and tumor information such as tumor location,tumor size,tumor differentiation degree,preoperative CEA level,and preoperative CA19-9 level between the local resection group and the radical surgery group,so the two groups were comparable.2.In terms of average operative time,postoperative bowel ventilation time,postoperative ureter removal time,and average postoperative hospitalization time,the local resection group outperformed the radical surgery group.3.In the comparison of surgical complications between the local resection group and the radical surgery group,a total of 2 complications occurred in the local excision group and 15 complications occurred in the radical surgery group,with a statistically significant difference in the total complication rate between the two groups.4.Comparison of the tumor recurrence rate,overall survival rate,and disease-free survival rate between the local resection group and the radical surgery group: One case of local recurrence occurred in the local resection group,with a recurrence rate of 4.17 percent;one patient had liver metastasis and one patient had local recurrence in the radical surgery group,with a recurrence rate of 3.85 percent.In terms of overall tumor survival（P=0.9）and disease-free survival（P=0.9）,there was no statistically significant difference between the two groups.Conclusion:1.Local excision can achieve the same safety and clinical outcomes as radical surgery in patients with T1N0M0 rectal cancer.2.Local resection has significant advantages in terms of operative time,postoperative recovery and surgical complications,and permanent colostomy can be avoided to a certain extent,which helps to improve the quality of survival of patients.3.For patients with early stage rectal cancer who are elderly,have poor cardiopulmonary function and do not wish to undergo radical surgery,local excision can be the preferred treatment option.