PROSPECTIVE EVALUATION OF LOCAL EXCISION FOR SMALL RECTAL CANCERS

OBJECTIVE: Most data on local excisions for rectal cancer are based on retrospective studies. We review the results of a prospective registr y of patients eligible for local excision of rectal cancer using a tra nsanal, transsphincteric, or transcoccygeal technique combined with mu ltimodality therapy for lesions penetrating the muscularis propria (T2 ) or perirectal fat (T3). METHODS: Patients with lesions less than 4 c m in diameter and less than 10 cm from the dentate line, with no evide nce of distant metastases or invasion into the perirectal fat, were el igible for local excision. Patients with invasion into the muscularis propria (T2) or greater (T3) received adjuvant chemoradiation therapy. RESULTS: Forty-eight patients have been followed prospectively. Avera ge age is 63 years. Thirty-three patients underwent a transanal excisi on. Fifteen patients underwent either a transsphincteric or technique excision. There was no perioperative mortality. Pathology revealed 1 T is, 21 T1, 21 T2, and 5 T3 cancers. Mean follow-up is 40.5 months. Can cer-related overall mortality was 4 percent, Overall local or distant recurrence rate was 8 percent(4/48). Recurrence appeared to be related to presence of a positive margin or aggressive histology (lymphatic i nvasion). Local recurrences were treated with salvage therapy. CONCLUS ION: Local excision can be used selectively for small rectal cancers, with minimum morbidity. Recurrence rates are low (8 percent). Patients with either a positive margin or lymphatic invasion need to be consid ered for further therapy, including abdominoperineal resection, even w ith T1 lesions. Adjuvant chemoradiation appears to be a benefit fur al l T2 or T3 cancers.