{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T10:44:43Z","timestamp":1776336283176,"version":"3.51.2"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Local excision (LE) for T1 rectal cancer may be recommended in those with low\u2010risk disease, while resection is typically recommended in those with a high risk of luminal recurrence or lymph node metastasis. The aim of this work was to compare survival between resection and LE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This was a population\u2010based retrospective cohort study set in the Canadian province of Ontario. Patients were individuals with T1Nx rectal cancer between 2010 and 2014 and demographics, disease characteristics, treatments and outcomes were determined using linked administrative databases. This study does not include clinical information regarding individual patient treatment decisions. The main outcome measure was overall survival (OS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 719 patients were identified, including 359 with upfront resection, 113 with <jats:styled-content style=\"fixed-case\">LE<\/jats:styled-content> and immediate resection (&lt;90\u2009days) and 247 with LE with definitive intent. The majority of <jats:styled-content style=\"fixed-case\">LEs<\/jats:styled-content> were performed via colonoscopy. Piecemeal excision (42% vs. 49%, <jats:italic>p<\/jats:italic>\u2009=\u20090.28) and positive margin (50% vs. 77%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) rates were high in both <jats:styled-content style=\"fixed-case\">LE<\/jats:styled-content> groups, with the highest rate in those with immediate resection. The prevalence of poor differentiation (&lt;5%, <jats:italic>p<\/jats:italic>\u2009=\u20090.70) and lymphovascular invasion (<jats:styled-content style=\"fixed-case\">LVI<\/jats:styled-content>) (14%, <jats:italic>p<\/jats:italic>\u2009=\u20090.80) was similar across groups. In those with LE with definitive intent, 21% ultimately underwent resection (median 150\u2009days, <jats:styled-content style=\"fixed-case\">interquartile range<\/jats:styled-content> 114\u2013181\u2009days) and 4% received radiation. There was no difference in 5\u2010year <jats:styled-content style=\"fixed-case\">OS<\/jats:styled-content> between groups (resection\u00a083.2% vs. <jats:styled-content style=\"fixed-case\">LE<\/jats:styled-content> and immediate resection\u00a082.3% vs. definitive <jats:styled-content style=\"fixed-case\">LE<\/jats:styled-content> 83.3%; <jats:italic>p<\/jats:italic>\u2009=\u20090.33). Adjusted analyses demonstrated no association between approach and survival [definitive intent <jats:styled-content style=\"fixed-case\">LE<\/jats:styled-content> hazard ratio (<jats:styled-content style=\"fixed-case\">HR)<\/jats:styled-content> 0.97 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.70\u20131.35), <jats:styled-content style=\"fixed-case\">LE<\/jats:styled-content> and immediate resection <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 0.97 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.60\u20131.45), upfront resection <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 1 (Ref); <jats:italic>p<\/jats:italic>\u2009=\u20090.98]. Differentiation, piecemeal excisions and <jats:styled-content style=\"fixed-case\">LVI<\/jats:styled-content> were not associated with <jats:styled-content style=\"fixed-case\">OS<\/jats:styled-content> in the <jats:styled-content style=\"fixed-case\">LE<\/jats:styled-content> groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There were no observed differences in survival between those who underwent resection, LE and immediate resection and definitive intent LE. Although, these are observational data, they call into question the reflexive decision to offer radical resection for those with suspected T1 rectal cancer.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.17276","type":"journal-article","created":{"date-parts":[[2025,1,11]],"date-time":"2025-01-11T01:14:02Z","timestamp":1736558042000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Local excision for <scp>T1<\/scp> rectal cancer: A population\u2010based study of practice patterns and oncological outcomes"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3498-2634","authenticated-orcid":false,"given":"Kelly E.","family":"Brennan","sequence":"first","affiliation":[{"name":"Division of General Surgery, Department of Surgery Queen's University  Kingston Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ameer O.","family":"Farooq","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery Queen's University  Kingston Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7668-4096","authenticated-orcid":false,"given":"Tyler J.","family":"Mckechnie","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa H.","family":"Wiseman","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery Queen's University  Kingston Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weidong","family":"Kong","sequence":"additional","affiliation":[{"name":"Cancer Care and Epidemiology Queen's University  Kingston Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare R.","family":"Bankhead","sequence":"additional","affiliation":[{"name":"Centre for Evidence Based Medicine University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl J.","family":"Heneghan","sequence":"additional","affiliation":[{"name":"Centre for Evidence Based Medicine University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandip S.","family":"Rai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Queen's University  Kingston Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil V.","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery Queen's University  Kingston Ontario Canada"},{"name":"Cancer Care and Epidemiology Queen's University  Kingston Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,10]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21395"},{"key":"e_1_2_13_3_1","unstructured":"Canadian Cancer Society.Canadian Cancer Statistics Advisory Committee in collaboration with the Canadian Cancer Society SC and the PHA of C. Canadian Cancer Statistics 2023.2023.http:\/\/cancer.ca\/Canadian\u2010Cancer\u2010Statistics\u20102023\u2010EN"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.0071"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(19)32319\u20100"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2021.11.002"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6127"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.2078\u20106891.2015.022"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02236551"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010005\u20100063\u20103"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12129"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535\u2010013\u20100881\u20103"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463\u20101318.2012.03130.x"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12657"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16716"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151\u2010009\u20100521\u20103"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.2196\/38874"},{"key":"e_1_2_13_18_1","unstructured":"Cancer Care Ontario.Ontario Cancer Registry.https:\/\/www.cancercareontario.ca\/en\/cancer\u2010care\u2010ontario\/programs\/data\u2010research\/ontario\u2010cancer\u2010registry"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001538"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010200210000\u201000015"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010004\u20106320\u2010z"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000283"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.14340"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.00184"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20101253(19)30410\u20108"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001762"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010009\u20100359\u2010y"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.01.867"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000390"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463\u20101318.2007.01464.x"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.17276","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T08:15:17Z","timestamp":1753517717000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.17276"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/codi.17276"],"URL":"https:\/\/doi.org\/10.1111\/codi.17276","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2024-05-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e17276"}}