Local excision of rectal carcinoma: A safe alternative for more advanced tumors?

Background and Objectives: Local excision of rectal carcinoma has primarily been limited to patients with small (13 cm), early rectal carcinoma. We wa nted to determine whether local excision (transanal or transacral), when co mbined with selective chemoradiation therapy, would be adequate treatment f or patients with larger (>3 cm) and more advanced T3 and N1 tumors. Methods: A prospective study of 20 patients with clinical T1-T3, N0-N1 rect al carcinoma was initiated in 1990. Local excision (transanal or transacral ) was performed on all patients. Sixteen patients were treated with postope rative 5-fluorouracil (5-FU) and leucovorin (LV) combined with radiation th erapy; six high-risk patients (T3 or N1) received an additional 6 months of 5-FU and LV. All patients were followed for a minimum of 4 years. Results: Tumor size ranged from 2 to 5.5 cm (mean, 3.6 cm). Histology revea led well or moderate differentiation (19/20), gross or microscopic ulcerati on (14/20), and vessel invasion (5/20). Mucosal margins were 3-12 mm (mean, 8.3 mm); radial margins were clear in all patients except one (microscopic ally positive). Five patients had T3 tumors two had node positive tumors (N 1). With a median follow-up of 56 months (48-71), there have been no local or regional failures and two patients have died from metastatic disease. Conclusions: Local excision, when combined with selective chemoradiation th erapy, can be safely applied to patients with large (>3 cm) and more advanc ed T3 and N1 rectal carcinomas. J. Surg. Oncol. 1999;70:235-238, (C) 1999 W iley-Liss, Inc.