Local excision with preoperative irradiation for T2 or T3 distal rectal cancer. Long time results.

Study aim: To evaluate, in a prospective study of a cohort of patients, the local recurrence rate of T2 or T3 rectal cancers treated by transanal exci sion after preoperative irradiation. Patients and methods: Between 1992 and 1999, 34 patients were treated after radiotherapy by a local excision for a distal rectal carcinoma limited to (stage T2) or invading through the muscular layer (stage T3). Four patients were excluded either for palliative treatment or lost for follow-up. Thirt y patients were included in the study (8 uT2, 8 uT3, 14 undetermined preirr adiation stage). Results: After a 74-month mean follow-up (median: 46), the 5-year local rec urrence rate was 33%. Even among subgroups of patients with a significant r isk factor for local recurrence (size > 40 mm, clear margin < 2 mm, uT3 sta ge versus uT2) there were no benefits from irradiation. Conclusion: Local excision of T2 or T3 rectal cancers is associated with an elevated local recurrence rate. This result is demonstrated even after adj unction of a preoperative irradiation. So, local treatment must be restrict ed to clearly informed patients who definitively refuse a radical intervent ion. (C) 2001 Editions scientifiques et medicales Elsevier SAS.