TRANSANAL ELECTRORESECTION OF SMALL RECTAL-CANCER - A SOLE TREATMENT

PURPOSE: Because abdominoperineal resection is associated with high mo rbidity and mortality, there is interest in local treatment of distal rectal carcinoma. Our technique of transanal electroresection ensures full-thickness tumor excision and complete histopathologic examination . METHODS: From July 1983 to July 1990, 227 patients underwent surgery . Criteria for cure were no extramural invasion (61 exclusions) and ne gative margins (34 exclusions). Six patients underwent postoperative r adiotherapy and, therefore, were excluded. RESULTS: Among those includ ed were 126 patients (66 men), who had a mean age of 68 +/- 11 (median , 68) years. Median tumor size was 35 mm. Distance from anal verge was less than 6 cm for 68 percent and 6-10 cm for 30 percent of patients. Deepest layer invaded was as follows: submucosa (T1), 35 percent; inn er muscular la) er (T2a), 42 percent; outer muscular layer (T2b), 23 p ercent. There was one postoperative death. Immediate postoperative cou rse was uneventful for 94 percent of patients, at long-term, five case s of incontinence and two stenoses were noted (6 patients). Median fol low-up was 88 (1-137) months. Global survival was 71 and 46 percent, a nd cancer-specific survival was 85 and 81 percent at 5 and 10 pears, r espectively. Of 35 patients (28 percent) with recurrence, 24 were trea ted. Global survival after recurrence was 72 and 50 percent at one and two years, respectively. The only pejorative prognostic factors isola ted for survival or recurrence were mucinous contingent and intratumor al vascular invasion. CONCLUSION: Results of local treatment for recta l carcinoma in selected patients are favorable (5-year specific surviv al, 85 percent). Decisive prognostic factors are seldom isolated, but some patients would benefit from an adjuvant therapy.