IMMEDIATE VS SALVAGE RESECTION AFTER LOCAL TREATMENT FOR EARLY RECTAL-CANCER

PURPOSE: There is an increasing awareness of local procedures to treat early stage rectal cancer. Abdominoperineal resection (APR) or low an terior resection (LAR) has been recommended if adverse pathologic find ings are encountered in the local excision specimen. No data compare t he impact on survival of ''immediate'' resection for adverse features vs. ''salvage'' resection for clinical recurrence. METHODS: We reviewe d retrospectively 155 patients who underwent initial curative treatmen t of invasive rectal cancer by excision (91), snare-cautery (44), and fulguration (20). RESULTS: Twenty-one patients underwent APR/LAR immed iately after initial local treatment, whereas another 21 patients unde rwent salvage APR/LAR for local recurrence. The disease-free survival after APR/LAR was 94.1 percent for the immediate group and 55.5 percen t for the delayed group (P < 0.05). CONCLUSION: This decreased surviva l observed after delayed resection supports the recommendation for imm ediate APR/LAR when adverse pathologic features are present in the exc ision specimen.