REAPPRAISAL OF RADICAL LOCAL EXCISION FOR CARCINOMA OF THE RECTUM

Outcome in all 167 patients treated by radical local excision for rect al carcinoma between 1948 and 1984 at St Mark's Hospital was assessed in terms of the original tumour differentiation except for 15 patients with incomplete follow-up or ungraded tumours. Fifty-six of the 152 p atients had low-grade tumours, with one death from carcinoma in this g roup. Of 81 patients with average-grade tumours, ten died from carcino ma of the rectum: two after early reoperation and eight following recu rrence. Six of 15 patients with high-grade tumours underwent early reo peration and three of these died from carcinoma. Among the nine patien ts who did not undergo early reoperation there were three related deat hs (two from carcinoma, one after rectal excision for recurrence). Loc al excision remains a valid therapy for suitable patients with low-gra de tumours but is not recommended for those with average-grade lesions . The necessity for early reoperation in patients with high-grade tumo urs is questioned.