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Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Copyright © 2019 The Korean Society of Coloproctology
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
Variable | Total (n = 268) | TAE (n = 61) | TME (n = 207) | P-value |
---|---|---|---|---|
Age (yr) | 58.8 ± 9.6 | 58.0 ± 9.5 | 59.0 ± 9.6 | 0.290 |
Female sex | 117 (43.7) | 28 (45.9) | 89 (43.0) | 0.770 |
Distance from anal verge (cm) | 6.2 ± 2.6 | 4.1 ± 2.0 | 6.8 ± 2.4 | <0.001 |
Tumor size ≥3 cm | 54 (22.5) | 8 (15.7) | 46 (24.3) | 0.260 |
Lymph node metastasis | 15 (7.3) | |||
Deep submucosal invasion | 174 (64.9) | 32 (52.5) | 142 (68.6) | 0.020 |
Lymphovascular invasion | 30 (11.2) | 4 (6.6) | 26 (12.6) | 0.250 |
Unfavorable histology | 4 (1.5) | 2 (3.3) | 2 (1.0) | 0.224 |
Elevated CEA | 5 (1.9) | 3 (5.1) | 2 (1.0) | 0.078 |
Growth type | 0.033 | |||
Expanding | 194 (78.9) | 45 (90.0) | 149 (76.0) | |
Infiltrative | 52 (21.1) | 5 (9.6) | 47 (24.0) | |
With risk factor | 176 (42.9) | 32 (52.5) | 144 (69.6) | 0.013 |
Chemotherapy | 48 (17.9) | 10 (16.4) | 38 (18.4) | 0.850 |
Radiation therapy | 28 (10.4) | 18 (29.5) | 10 (4.8) | <0.001 |
Outcome | 5 Years |
10 Years |
P-value | ||
---|---|---|---|---|---|
TAE | TME | TAE | TME | ||
Overall survival (%) | 95 | 97 | 91 | 90 | 0.910 |
Without risk factor | 97 | 100 | 96 | 94 | 0.680 |
With risk factor | 94 | 96 | 90 | 88 | 0.890 |
Cancer-specific survival (%) | 98 | 100 | 98 | 100 | 0.220 |
Without risk factor | 100 | 100 | 100 | 100 | 0.220 |
With risk factor | 97 | 99 | 97 | 99 | 0.320 |
Recurrence-free survival (%) | 90 | 99 | 86 | 99 | <0.001 |
Without risk factor | 96 | 100 | 93 | 100 | 0.038 |
With risk factor | 84 | 98 | 80 | 97 | 0.001 |
Local recurrence rate (%) | 10 | 0 | 10 | 0 | <0.001 |
Without risk factor | 4 | 0 | 4 | 0 | 0.140 |
With risk factor | 16 | 1 | 16 | 1 | <0.001 |
Sex | Age | Recurrence type | Operation | Salvage surgery | Last status | Recurrence-free survival (mo) | Survival after recurrence (mo) | Adjuvant therapy after recurrence |
---|---|---|---|---|---|---|---|---|
F | 35 | LR | TAE | Yes | Alive | 44 | 46 | CTx + RTx |
F | 47 | LR | TAE | Yes | Dead | 20 | 96 | CTx + RTx |
F | 48 | LR | TAE | No | Alive | 58 | 0 | No |
F | 62 | LR | TAE | Yes | Alive | 14 | 161 | No |
F | 63 | LR | TAE | Yes | Alive | 39 | 103 | CTx + RTx |
M | 53 | SR | TAE | No | Dead | 115 | 79 | CTx + RTx |
F | 46 | SR | TAE | Yes | Dead | 86 | 38 | CTx |
F | 59 | LR + SR | TAE | No | Dead | 21 | 10 | CTx |
M | 49 | LR | TME | Yes | Alive | 8 | 109 | CTx + RTx |
M | 63 | SR | TME | No | Dead | 84 | 51 | No |
F | 54 | SR | TME | Yes | Alive | 9 | 161 | CTx + RTx |
M | 54 | SR | TME | Yes | Dead | 5 | 16 | CTx |
Variable | Univariate analysis |
Multivariate analysis |
||||
---|---|---|---|---|---|---|
HR | 95% CI | P-value | HR | 95% CI | P-value | |
Sex | ||||||
Male | 1.000 | |||||
Female | 2.661 | 0.801–8.839 | 0.110 | |||
Operation type | ||||||
TME | 1.000 | 1.000 | ||||
TAE | 6.759 | 2.035–22.453 | 0.002 | 6.759 | 2.035–22.453 | 0.002 |
Tumor size (cm) | ||||||
<3 | 1.000 | |||||
≥3 | 0.841 | 0.179–3.965 | 0.830 | |||
Distance from AV (cm) | ||||||
<5 | 1.000 | |||||
≥5 | 0.386 | 0.116–1.282 | 0.560 | |||
Depth of tumor | ||||||
Shallow SM invasion | 1.000 | |||||
Deep SM invasion | 2.839 | 0.622–12.959 | 0.180 | |||
Histology | ||||||
Favorable | 1.000 | |||||
Unfavorable | 7.183 | 0.923–55.881 | 0.060 | |||
Lymphovascular invasion | ||||||
No | 1.000 | |||||
Yes | 1.701 | 0.373–7.765 | 0.490 | |||
CEA | ||||||
Normal | 1.000 | |||||
Elevated | 4.914 | 0.634–38.084 | 0.130 | |||
Radiation therapy | ||||||
No | 1.000 | |||||
Yes | 2.883 | 0.780–10.659 | 0.110 | |||
Chemotherapy | ||||||
No | 1.000 | |||||
Yes | 0.945 | 0.207–4.312 | 0.180 |
Variable | Univariate analysis |
Multivariate analysis |
||||
---|---|---|---|---|---|---|
HR | 95% CI | P-value | HR | 95% CI | P-value | |
Sex | ||||||
Male | 1.000 | |||||
Female | 7.844 | 0.944–65.152 | 0.060 | |||
Operation type | ||||||
TME | 1.000 | 1.000 | ||||
TAE | 20.788 | 2.503–172.686 | 0.005 | 19.066 | 2.274–159.832 | 0.007 |
Tumor size (cm) | ||||||
<3 | 1.000 | |||||
≥3 | 0.033 | 0.000–118.142 | 0.420 | |||
Distance from AV (cm) | ||||||
<5 | 1.000 | |||||
≥5 | 0.316 | 0.061–1.627 | 0.170 | |||
Depth of tumor | ||||||
Shallow SM invasion | 1.000 | |||||
Deep SM inv. | 3.335 | 0.401–27.701 | 0.650 | |||
Histology | ||||||
Favorable | 1.000 | 1.000 | ||||
Unfavorable | 12.110 | 1.455–100.790 | 0.021 | 6.846 | 0.808–57.976 | 0.080 |
LVI | ||||||
No | 1.000 | |||||
Yes | 1.370 | 0.165–11.382 | 0.770 | |||
CEA | ||||||
Normal | 1.000 | |||||
Elevated | 4.914 | 0.634–38.084 | 0.130 | |||
Radiation therapy | ||||||
No | 1.000 | |||||
Yes | 1.468 | 0.177–12.196 | 0.720 | |||
Chemotherapy | ||||||
No | 1.000 | |||||
Yes | 0.037 | 0.000–167.320 | 0.440 |
Values are presented as mean ± standard deviation or number (%). TAE, transanal excision; TME, total mesorectal excision; CEA, carcinoembryonic antigen. Deep submucosal invasion included sm2–3 for sessile tumor and Haggitt level 3–4 for pedunculated tumor.
TAE, transanal excision; TME, total mesorectal excision. Risk factors included deep submucosal invasion, lymphovascular invasion, and poor histology results.
LR, local recurrence; SR, systemic recurrence; TAE, transanal excision; TME, total mesorectal excision; CTx, chemotherapy; RTx, radiation therapy.
HR, hazard ratio; CI, confidence interval; TAE, transanal excision; TME, total mesorectal excision; AV, anal verge; SM, submucosal; CEA, carcinoembryonic antigen.
HR, hazard ratio; CI, confidence interval; TME, total mesorectal excision; TAE, transanal excision; AV, anal verge; SM, submucosal; LVI, lymphovascular invasion; CEA, carcinoembryonic antigen.