LOCAL EXCISION OF RECTAL-CANCER FOR CURE - SHOULD WE ALWAYS REGARD RIGID PATHOLOGICAL CRITERIA

BACKGROUND/AIMS: The purposes of this study were to assess the relatio nship between the incidence of recurrence and the pathologic criteria usually applied to the selection of patients for curative local excisi on of rectal carcinoma and to determine whether failure to fulfill one of these criterias is always an indication for secondary abdominoperi neal resection (APR). METHODOLOGY: From 1982 to 1992, 30 patients with rectal carcinoma (mean age: 69 +/- 10 years) were treated by local ex cision (LE). Univariate analysis of the cancer recurrence rate accordi ng to pathologic criteria was performed. RESULTS: The mean follow-up w as 57 +/- 40 months (range: 6-145). Five patients (17%) had recurrent disease (local in 3, distant in 1, and local and distant in I). Two of the three local cases were successfully treated. At the end of follow -up, 90% of the patients had no evidence of recurrence, and the rectal cancer-specific death rate was 10%. Although not significant, tumor p enetration beyond the submucosa and vessel or nerve invasion were asso ciated with an increased incidence of cancer recurrence. Tumor size an d differentiation, and the presence of a mucinous component were not a ssociated with a significant increase in recurrence. According to the usual pathologic criteria proposed for curative LE, 20 patients should , theoretically, have undergone secondary APR. However, 16 of them (80 %) were treated by LE only, and at the end of follow-up, 17 (85%) were alive without recurrence. CONCLUSIONS: The rigid rule of systematical ly performing secondary APR after LE for rectal carcinoma when one or more pathologic selection criteria are not met should perhaps be recon sidered, especially for tumors exceeding 3 cm in diameter, moderately differentiated tumors, and in incidences when a mucinous component is present. However, in cases of vessel, nerve or muscular invasion, seco ndary APR is probably the best choice for cure.