Transanal excision for low rectal cancers is curative in early-stage disease with favorable histology

Controversy still exists as to the optimal treatment of early-stage low rec tal cancers. Standard resections such as abdominal perineal resections or l ow anterior resection with coloanal anastomosis can be associated with sign ificant morbidity. Local excision has been considered as a potentially far less morbid option for these patients. We identified 20 patients from our p rospective tumor registry database that underwent transanal resection of ea rly rectal cancers between 1988 and 1998. Five patients had carcinoma in si tu and 15 patients had T-1 lesions. All T-1 lesions were well or moderately well differentiated, and none had lymphovascular invasion. The mean tumor size was 2.65 cm and the average distance from the anal verge was 4.55 cm. One patient required temporary colostomy because of postoperative complicat ions. Four patients had postoperative adjuvant therapy (radiation alone, tw o; radiation and chemotherapy, two) for close margins after they refused an abdominal perineal resection. With a median follow-up of 60 months there w ere no recurrences and no cancer-related deaths. This series suggests that transanal excision is a safe and effective treatment for selected early low rectal cancers with favorable histology.