Discussants: J.G. Guillem (New York, NY)
I want to congratulate you for utilizing the SEER data to look at this question; but, as we know, this is a bit of an old question, the idea of a carcinoma in situ versus an invasive cancer. I wonder, with access to this data set, whether you can perhaps drill down a bit further by not comparing the colon and the rectum, or uniting them, which is a bit of uniting apples and oranges, and perhaps drill down to the more specific questions that have been suggested by the previous individuals.
I think the major question with colon, as you know, is the pedunculated versus sessile malignant polyp; what is the adequacy of the resection for that? And in the rectum, there are upper/lower rectal cancers, early invasion, and submucosal invasion. So, I think that is the kind of data for which we are looking.
So, I congratulate you for using the data, but I would perhaps hope that in the future you would look at the next subsequent studies, drilling down to the more specific timely questions.
Response From A. Bhangu (London, UK)
I think that it is extremely interesting because, unfortunately, that level of data required is not necessarily in the SEER database. What is interesting is why aren't these patients all going into randomized trials? Existing trials are struggling to recruit, despite this study showing that there clearly are enough patients. It may be that these studies are very hard to recruit to, which is largely an equipoise question for clinicians.
I think that putting these patients in large scale, multicenter randomized trialswould really provide this evidence and data required to keep us going for the next 20 years.