Results of local excision of benign and malignant rectal lesions

Local excision of selected rectal cancers is an acceptable alternative to r adical surgery. The results of local excision of various rectal lesions usi ng either the transanal or trans-sacral approach were reviewed over a 10-ye ar period at this institution. A total of 56 procedures were performed on 4 7 patients (50 transanal/six trans-sacral). The trans-sacral approach was u sed six times on five patients for lesions averaging a distance of 8 cm fro m the anal verge. The transanal. approach was used 50 times on two patients for lesions occurring at an average distance of 5 cm from the anal verge. Twenty-six malignant lesions were excised (25 transanal/one trans-sacral) w ith pathologies ranging from poorly to well-differentiated adenocarcinoma, Staging included 12 T-1 lesions (46%), 10 T-2 lesions (38%), and four T-3 l esions (16%), Eighteen malignancies were completely excised and recurrence occurred in four of 18 (22%) with an average follow-up of 2.3 years (range 0-10 years). Local recurrence occurred in two patients (T-1 and T-2 lesions ) and recurrence was in the form of distant metastasis in two patients (two T-3 lesions). Three of the recurrences occurred in patients with T-3 lesio ns (three of four; 75%), two occurred in a patient with a T-2 lesion (two o f 10; 20%), and one occurred in a patient with a T-1 lesion (one of 12; 8%) . There were no cancer-related deaths during the study period. Twenty-six p remalignant lesions (adenomatous polyps) and four benign lesions were excis ed (25 transanal/five trans-sacral). Local recurrence occurred 10 times wit h an average follow-up of 1.8 years. In conclusion local excision of certai n rectal cancers is an acceptable alternative in the treatment of these mal ignancies.