Radical Resection Compared to Local Excision for Very Old Patients With Stage 1 Rectal Cancer: An Exact‐Match Analysis of the SEER Database

ABSTRACT Background We assessed overall survival (OS) and cancer‐specific‐survival (CSS) of radical resection compared to local excision for stage 1 rectal cancer in very old patients (≥ 80 years). Methods This retrospective cohort study included patients aged ≥ 80 years who underwent surgery for stage 1 rectal cancer from the SEER database from 2000–2020. Patients were divided into radical resection and local excision groups, and were exact matched for T stage, tumor grade, and tumor size. The main outcome measures were OS and CSS. Results 6379 patients ≥ 80 years underwent local or radical resection of stage 1 rectal cancer; 51.9% were female and 47% had T1 tumors. After matching, 1125 patients were included in each group. The median OS was longer in patients who underwent radical resection (60 months vs. 51 months, p = 0.009), yet there were no significant differences in CSS between the two groups. When stratified by the T stage, there was no benefit for radical resection in T1 tumors ( p = 0.33). In multivariate analysis, radical resection and local excision had similar hazard of mortality (HR 1.03, 95%CI 0.76–1.38). Conclusion Radical resection and local excision had similar CSS in very old patients with stage 1 rectal cancer. A personalized approach considering patient status and treatment goals should be used for each patient.