LOCAL THERAPY OF RECTAL TUMORS

PURPOSE: The aim of the study is to outline the rising importance of l ocal treatment of rectal tumors and a changing strategy in therapy of early rectal cancer. METHODS: As the surgical procedure, transanal end oscopic microsurgery was used. Indications for the local procedure wer e pT1 low-risk tumors and tumors of higher stages in patients with sev ere risk factors and of those who refused the operation according to o ncologic guidelines. RESULTS: A total of 236 rectal adenomas and 98 ca rcinomas were locally excised using the transanal endoscopic microsurg ery technique. Mortality rate was 0.3 percent, and rate of complicatio ns requiring surgical reintervention was 5.5 percent in adenomas and 8 percent in carcinomas. Final histology of removed carcinomas revealed 56 pT1, 27 pT2, and 15 pT3 stages. After an average follow-up time of 24 months, two recurrences were observed in the group of patients wit h pT1 low-risk carcinomas who only underwent local therapy. in both ca ses, a second intervention for cure was undertaken but for tumors in a late stage. CONCLUSIONS: In selected cases, local therapy of rectal c arcinoma avoids high morbidity and mortality of the classical operatio n. Quality of life will be improved, especially if an artificial anus can be avoided. In case of recurrence, the chance of a secondary proce dure for cure is not to be underestimated.