结直肠癌筛查计划已导致早期结直肠癌的转变，在某些情况下，可以使用局部切除进行治疗。然而，局部切除后再完成全直肠系膜切除（两阶段方法）的结果可能不如初次全直肠系膜切除（一阶段方法）。这项人群研究的目的是确定荷兰早期直肠癌治疗策略的分布，并将初次全直肠系膜切除术与局部切除后再完成全直肠系膜切除术的短期结果进行比较。 短期数据2012 年至 2020 年间，荷兰仅接受局部切除、初次全直肠系膜切除或局部切除后完成全直肠系膜切除的 cT1-2 N0xM0 直肠癌患者的数据收集自荷兰结直肠审计。根据治疗组对患者进行分类，并在多重插补和倾向评分匹配后进行逻辑回归。主要结局是末端造口率。从2015年到2020年，两阶段方法的比例从22.3%增加到43.9%。匹配后，纳入1062名患者。初次全直肠系膜切除组的末端造口率为 16.8%，而局部切除后再完成全直肠系膜切除组的末端造口率为 29.6%（P < 0.001）。初次全直肠系膜切除组的再干预率高于局部切除后再完成全直肠系膜切除组（16.7% vs 11.8%；P = 0.048）。在并发症、转化、改道造口、根治性切除、再入院和死亡方面没有观察到差异。这项研究表明，随着时间的推移，cT1-2 直肠癌越来越多地采用两阶段方法进行治疗。然而，局部切除后再完成全直肠系膜切除似乎与末端造口率升高相关。临床医生和患者在共同决策过程中意识到这种风险非常重要。© 作者 2024。由牛津大学出版社代表 BJS Foundation Ltd 出版。

Colorectal cancer screening programmes have led to a shift towards early-stage colorectal cancer, which, in selected cases, can be treated using local excision. However, local excision followed by completion total mesorectal excision (two-stage approach) may be associated with less favourable outcomes than primary total mesorectal excision (one-stage approach). The aim of this population study was to determine the distribution of treatment strategies for early rectal cancer in the Netherlands and to compare the short-term outcomes of primary total mesorectal excision with those of local excision followed by completion total mesorectal excision.Short-term data for patients with cT1-2 N0xM0 rectal cancer who underwent local excision only, primary total mesorectal excision, or local excision followed by completion total mesorectal excision between 2012 and 2020 in the Netherlands were collected from the Dutch Colorectal Audit. Patients were categorized according to treatment groups and logistic regressions were performed after multiple imputation and propensity score matching. The primary outcome was the end-ostomy rate.From 2015 to 2020, the proportion for the two-stage approach increased from 22.3% to 43.9%. After matching, 1062 patients were included. The end-ostomy rate was 16.8% for the primary total mesorectal excision group versus 29.6% for the local excision followed by completion total mesorectal excision group (P < 0.001). The primary total mesorectal excision group had a higher re-intervention rate than the local excision followed by completion total mesorectal excision group (16.7% versus 11.8%; P = 0.048). No differences were observed with regard to complications, conversion, diverting ostomies, radical resections, readmissions, and death.This study shows that, over time, cT1-2 rectal cancer has increasingly been treated using the two-stage approach. However, local excision followed by completion total mesorectal excision seems to be associated with an elevated end-ostomy rate. It is important that clinicians and patients are aware of this risk during shared decision-making.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.