SELECTION FACTORS FOR LOCAL EXCISION OR ABDOMINOPERINEAL RESECTION OFEARLY-STAGE RECTAL-CANCER

Background. This study reviews the experience of patients with early s tage rectal cancer managed by local excision or abdominoperineal resec tion to clarify the relative indications and results of these two appr oaches. Methods. From 1962 to 1991, 125 patients with T1 and T2 rectal cancer underwent local excision (56 patients) or abdominoperineal res ection (69 patients). Outcome was analyzed by stage, treatment, and pa thologic features of tumor grade and vessel involvement. Results. The 5-year actuarial recurrence-free survival and local control was 87% an d 96%, respectively, for 28 patients undergoing local excision with fa vorable histologic features (well or moderately well differentiated hi stologic findings without venous/lymph vessel involvement). These resu lts were 57% and 68% for 28 patients with unfavorable histologic featu res (poorly differentiated histology and/or venous/lymph vessel involv ement). For patients undergoing abdominoperineal resection, the 5-year actuarial recurrence-free survival and local control of 49 patients w ith favorable histologic features was 91% and 91%, respectively. These results were 79% and 89%, respectively, for patients with poorly diff erentiated histology or venous/lymph vessel involvement. Conclusions. For patients with T1 and T2 tumors having favorable histologic feature s, a satisfactory survival and local control was achieved for patients undergoing local excision or abdominoperineal resection. In contrast, patients with T1 and T2 tumors having poorly differentiated histologi c features and/or venous/lymph vessel involvement undergoing local exc ision or abdominoperineal resection appeared to have decreased rates o f survival and of local control. For these patients, radical resection combined with pelvic irradiation and 5-fluorouracil-based chemotherap y should be investigated.