LOCAL TREATMENT OF RECTAL-CANCER

While abdominoperineal resection with permanent colostomy is still req uired for most rectal cancers, sphincter-saving local treatment by mea ns of local excision, electrocoagulation or endocavitary contact radia tion can be used for some highly selected distal tumors. Local treatme nt avoids a permanent colostomy and Is associated with much lower morb idity and mortality rates than abdominoperineal resection. Strict crit eria for patient selection are essential to successful local treatment . Optimal candidates include patients exhibiting the following feature s of rectal cancer: a distal rectal cancer less than 8 cm from the ana l verge; a tumor with a diameter of 3 cm or less; a tumor that is well to moderately well differentiated histologically, and a tumor that is limited to the bowel wall. Preoperative studies such as transrectal u ltrasonography enhance the accuracy of preoperative staging. In proper ly selected patients, the results of local treatment are equivalent to those of abdominoperineal resection of comparable tumors. Close follo w-up is essential, and turner recurrence can be treated for cure by ab dominoperineal resection.