TRANSANAL LOCAL EXCISION OF SELECTED LOW RECTAL CANCERS

BACKGROUND: To determine if transanal local excision (TALE) of selecte d early low rectal cancer is an effective alternative to more radical resection and to determine the need for adjuvant radiotherapy in these patients. METHODS: A retrospective analysis of all 47 cases referred for consideration of radiotherapy after TALE for low rectal cancer. RE SULTS: Indications for TALE were elective, 32; concurrent medical prob lems, 11; and refusal of radical resection, 4, Median follow-up was 52 months. Local recurrence occurred in 7 of 27 T1 cases, 5 of 17 T2, an d 2 of 3 T3, Three of 23 irradiated patients developed local recurrenc e, compared with 11 of 24 unirradiated (P = 0.023). Of 28 cases with f avorable histological features, 1 of 13 irradiated patients developed local recurrence, compared with 4 of 16 unirradiated (P = 0.22). Seven patients had salvage resection, and 3 of these are alive with no evid ence of disease at 21, 39, and 71 months postsalvage. Recurrence-free survival at 5 years was 81% in the irradiated patients and 52% in the unirradiated (P = 0.025). CONCLUSIONS: Transanal local excision of sel ected low rectal cancers, combined with adjuvant radiotherapy, results in a low recurrence rate and is, therefore, an effective alternative to more radical resection. (C) 1998 by Excerpta Medica, Inc.