TRANSANAL TREATMENT OF RECTAL-CANCER - ABLATIVE METHODS AND OPEN RESECTION

Conservative surgical techniques are an alternative to radical surgery for selected patients with rectal carcinoma. The goals of conservativ e management are to select patients with low risk for nodal metastases and achieve local tumor control while preserving anal sphincter funct ion. Patient selection is critical to achieve this outcome because pro perly selected patients can obtain results comparable to radical surge ry. Selection is based on preoperative histologic characteristics and endorectal ultrasonography. Predictors of pelvic lymph node metastasis risk include tumor grade, depth of penetration, mucinous features, an d vascular and lymphatic invasion. Endorectal ultrasound (ERUS) is imp ortant in accurately staging the lesion by identifying both depth of i nvasion and presumptive nodal status. The options for local therapy re viewed include techniques of full-thickness local excision and ablativ e procedures including endocavitary irradiation, electrocoagulation, a nd laser therapy. The techniques of full-thickness transanal excision and endocavitary irradiation are described with results from the Unive rsity of Minnesota experience. Semin. Surg. Oncol. 15:101-113, 1998. ( C) 1998 Wiley-Liss, Inc.