Transanal excision with adjuvant therapy for pT1N0 rectal tumors with high‐risk features offers equivalent survival to radical resection: A National Cancer Database analysis

Background Current guidelines favor transabdominal radical resection (RR) over transanal local excision (TAX) followed by adjuvant therapy (TAXa) for pT1N0 rectal tumors with high‐risk features. Comparison of oncologic outcomes between these approaches is limited, although the former is associated with increased postoperative morbidity. We hypothesize that such treatment strategies result in equivalent long‐term survival. Methods A retrospective cohort study was conducted using the National Cancer Database (2010–2016) to identify patients with pT1N0 rectal adenocarcinoma with high‐risk features who underwent TAX or RR for curative intent. The primary outcome was 5‐year overall survival (OS), evaluated with log‐rank and Cox‐proportional hazards testing. Results A total of 1159 patients (age 67.4 ± 12.9 years; 56.6% male; 83.3% White) met study criteria, of which 1009 (87.1%) underwent RR and 150 (12.9%) underwent TAXa. Patients undergoing TAXa had shorter lengths of stay (RR = 6.5 days, TAXa = 2.7 days, p