TRANSANAL EXCISION OF RECTAL-CARCINOMA

Twenty-two men and 16 women with a mean age of 67 years were treated f or rectal carcinoma by transanal excision. Patients presented with rec tal bleeding (63%), change in bowel habits (11%), rectal pain (4%), or were asymptomatic and discovered on screening proctosigmoidoscopy (22 %). The tumors were located from the anal verge to 8 cm proximally and ranged in size from 1 to 4 cm. Pathologic findings included adenocarc inoma (92%), squamous cell carcinoma (4%), and cloacogenic carcinoma ( 4%). Postoperative hospitalization averaged two days (0 to 29 days). O ne patient died of a perioperative myocardial infarction for an operat ive mortality of 3 per cent. Morbidity was 7 per cent and included uri nary retention and pneumonia. Postoperative radiation therapy was admi nistered to 11 patients with either undifferentiated tumors or invasio n into the muscularis propria. Follow-up in these 38 patients averaged 30 months. One patient died of metastatic carcinoma, and two patients developed local recurrence that was treated successfully by a low ant erior resection or abdominoperineal resection. Transanal excision of r ectal carcinoma can be performed in properly selected patients with go od overall survival and local control.