Outcomes of Organ-Preserving Local Excision Compared to Radical Resection in Stage I Early-Onset Rectal Cancer: A Propensity-Score SEER-Based Analysis.

Background: Organ-preserving approaches to rectal cancer have shown promising results in reducing adverse events and improving quality of life without compromising oncologic outcomes. This study aimed to compare the outcomes of organ-preserving local excision (LE) and radical resection (RR) for patients with stage I early-onset rectal cancer.

Methods: In this retrospective cohort study, patients aged 20-50 years with clinical stage I rectal cancer were identified in the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020). Patients were divided according to the type of surgery into two groups: LE and RR. The groups were propensity-score matched for tumor grade, stage, size, and pretreatment CEA levels. Overall survival (OS) and cancer-specific survival (CSS) were the main outcomes. Kaplan-Meier statistics and Cox regression analyses were used to assess survival.

Results: From a total of 5846 patients (LE = 1,654; RR = 4192), 545 LE and 1090 RR patients were included after matching. There were no significant differences between LE and RR in the 5-year restricted mean OS (57.6 vs 57.7 months, p = 0.769) or CSS (58.3 vs 58.2 months, p = 0.8). The type of surgical resection was not independently associated with OS (HR: 1.26, 95%CI: 0.77, 2.08, p = 0.357) or CSS (HR: 1.18, 95%CI: 0.62, 2.24, p = 0.611).

Conclusion: Our results underscore the need for tailored treatment guidelines for younger patients with stage I rectal cancer, and advocates for less invasive treatments that preserve organ function without altering oncological outcomes in patients with stage I early-onset rectal cancer.