我们的目的是评估直肠癌新辅助治疗后局部切除 (LE) 与直肠切除术相比的器官保留结果。 这项回顾性观察性研究使用国家癌症数据库 (NCDB)，纳入了局部晚期非转移性直肠癌 (ypT0-1) 患者2004 年至 2019 年间接受新辅助治疗的患者。对接受 LE 或直肠切除术的患者的结果进行了比较。使用包括患者人口统计、临床和治疗因素在内的 1:1 倾向评分匹配来最大程度地减少选择偏差。主要结局是总生存期 (OS)。纳入了 318,548 名患者中的 11,256 名患者，其中 526 名 (4.6%) 接受了 LE。匹配后，两组之间的平均 5 年 OS 相似（54.1 个月与 54.2 个月；p = 0.881）。阳性切除边缘（1.2% vs. 0.6%；p = 0.45）、病理 T 分期（p = 0.07）、30 天死亡率（0.6% vs. 0.6%；p = 1）和 90 天死亡率（1.5%） vs. 1.2%；p = 0.75) 组间具有可比性。 LE 患者的住院时间（1 天 vs. 6 天；p < 0.001）和 30 天再入院率（5.3% vs. 10.3%；p = 0.02）较低。 OS 预测因子的多变量分析显示男性（HR 1.38，95% CI 1.08-1.77；p = 0.009）、较高的 Charlson 评分（HR 1.52，95% CI 1.29-1.79；p< 0.001）、低分化癌（HR 1.61） ，95% CI 1.08-2.39；p = 0.02）、粘液癌（HR 3.53，95% CI 1.72-7.24；p< 0.001）和病理 T1（HR 1.45，95% CI 1.14-1.84；p = 0.002）死亡率增加的独立预测因素。 LE 与较差的 OS 无关（HR 0.91，95% CI 0.42-1.97；p = 0.82）。我们的研究结果显示，LE 与全直肠系膜切除（包括 ypT1 肿瘤）之间总体生存率没有显着差异。此外，无论采用何种手术方法，低分化或粘液性腺癌患者的预后通常较差。© 2024。作者。

We aimed to evaluate outcomes of organ preservation by local excision (LE) compared to proctectomy following neoadjuvant therapy for rectal cancer.This retrospective observational study using the National Cancer Database (NCDB) included patients with locally advanced non-metastatic rectal cancer (ypT0-1 tumors) treated with neoadjuvant therapy between 2004 and 2019. Outcomes of patients who underwent LE or proctectomy were compared. 1:1 propensity score matching including patient demographics, clinical and therapeutic factors was used to minimize selection bias. Main outcome was overall survival (OS).11,256 of 318,548 patients were included, 526 (4.6%) of whom underwent LE. After matching, mean 5-year OS was similar between the groups (54.1 vs. 54.2 months; p = 0.881). Positive resection margins (1.2% vs. 0.6%; p = 0.45), pathologic T stage (p = 0.07), 30-day mortality (0.6% vs. 0.6%; p = 1), and 90-day mortality (1.5% vs. 1.2%; p = 0.75) were comparable between the groups. Length of stay (1 vs. 6 days; p < 0.001) and 30-day readmission rate (5.3% vs. 10.3%; p = 0.02) were lower in LE patients. Multivariate analysis of predictors of OS demonstrated male sex (HR 1.38, 95% CI 1.08-1.77; p = 0.009), higher Charlson score (HR 1.52, 95% CI 1.29-1.79; p < 0.001), poorly differentiated carcinoma (HR 1.61, 95% CI 1.08-2.39; p = 0.02), mucinous carcinoma (HR 3.53, 95% CI 1.72-7.24; p < 0.001), and pathological T1 (HR 1.45, 95% CI 1.14-1.84; p = 0.002) were independent predictors of increased mortality. LE did not correlate with worse OS (HR 0.91, 95% CI 0.42-1.97; p = 0.82).Our findings show no overall significant survival difference between LE and total mesorectal excision, including ypT1 tumors. Moreover, patients with poorly differentiated or mucinous adenocarcinomas generally had poorer outcomes, regardless of surgical method.© 2024. The Author(s).