Local excision of rectal carcinoma

The purpose of this study was to identify the recurrence rate, the salvage rate after recurrence, arid the overall survival after local excision of re ctal adenocarcinomas. A retrospective medical chart review was performed in 31 consecutive patients with rectal adenocarcinoma who underwent local exc ision at Roswell Park Cancer Institute from January 1990 through December 1 999. After excision nine patients were excluded from further analysis becau se they were found to have advanced stage on pathologic examination (T-2 pr imary tumors with vascular invasion or T-3 tumors). Eight of the nine patie nts underwent abdominoperineal resection as definitive therapy. In the rema ining 22 patients who underwent transanal excision as definitive surgical t herapy there were 13 patients with T-1 tumors and nine patients with T-2 tu mors. Overall seven patients (32%) developed local recurrences after local excision. This included four patients with T-1 and three patients with T-2 primary tumors. All recurrences occurred in the seven patients who did not receive adjuvant chemoradiation. All patients underwent salvage resection o f the recurrence: Four patients who underwent salvage resection of the recu rrence remain without evidence of disease at a median follow-up of 19.5 mon ths. Local excision without adjuvant therapy has an unacceptably high rate of local recurrence. Although most patients who recur locally are salvaged by radical resection the long-term results after resection remain unknown. The use of adjuvant chemoradiation appears to reduce this high recurrence r ate and may eventually become a standard adjunct to local excision of recta l cancer.