Transanal excision was linked to lower surgical burden in lower rectal GIST

A multicenter retrospective cohort study compared transanal local excision with laparoscopic radical resection in 101 patients with lower rectal gastrointestinal stromal tumors (GISTs). Transanal excision was associated with shorter operations and fewer stomas, but the small number of recurrences limits conclusions about oncologic equivalence.

Cohort included 101 patients at two centers.
Transanal excision was associated with shorter operations.
No permanent stomas occurred in the transanal group.
Four recurrences limited assessment of cancer control.

Researchers reviewed 101 patients with primary lower rectal GISTs measuring 2 to less than 7 cm who underwent surgery at two centers between 2015 and 2023. The tumor’s lower margin was within 5 cm of the anal verge. The cohort included 74 patients treated with transanal local excision (taLE) and 27 with transabdominal laparoscopic radical resection (tlRR). The retrospective analysis used inverse probability of treatment weighting and doubly robust models to compare perioperative outcomes and recurrence-free survival (RFS). Median follow-up was 40 months.

After adjustment, taLE was associated with an operative time shorter by 118.4 minutes and a postoperative pain score lower by 2.5 points. No patient in the taLE group had a permanent stoma, compared with five patients in the tlRR group; temporary stoma and reoperation were also less likely with taLE. The reported advantages were largely consistent among patients with tumors at least 5 cm. Four recurrences occurred overall, with no statistically significant difference in RFS between groups (log-rank P=0.43).

The findings suggest taLE may reduce surgical burden in selected patients, but they do not establish equivalent cancer control. With only four recurrences, the study was underpowered to detect meaningful differences in RFS. Its retrospective design, limited follow-up and selection of patients for each procedure also constrain interpretation; confirmation in larger cohorts is needed.

In practice

For selected patients with primary lower rectal GISTs measuring 2 to less than 7 cm, this retrospective two-center study found transanal local excision was associated with less perioperative burden than laparoscopic radical resection, including fewer stomas and shorter operative time. These findings may inform discussion of organ-preserving surgical approaches, but do not establish that cancer control is equivalent or justify a change in practice. Only four recurrences occurred, follow-up was limited, and treatment selection was nonrandomized.

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Source

Surgical Endoscopy: Transanal local excision reduces surgical burden without evidence of increased recurrence in lower rectal GIST: a multicenter inverse probability of treatment weighting analysis ↗

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