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 rectal cancers. Standard resections such as abdominal perineal resections or low anterior resection with coloanal anastomosis can be associated with significant morbidity. Local excision has been considered as a potentially far less morbid option for these patients. We identified 20 patients from our prospective tumor registry database that underwent transanal resection of early rectal cancers between 1988 and 1998. Five patients had carcinoma in situ, and 15 patients had T1 lesions. All T1 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 complications. Four patients had postoperative adjuvant therapy (radiation alone, two; radiation and chemotherapy, two) for close margins after they refused an abdominal perineal resection. With a median follow-up of 60 months there were 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.