Results of local excision of benign and malignant rectal lesions

Local excision of selected rectal cancers is an acceptable alternative to radical surgery. The results of local excision of various rectal lesions using either the transanal or trans-sacral approach were reviewed over a 10-year period at this institution. A total of 56 procedures were performed on 47 patients (50 transanal/six trans-sacral). The trans-sacral approach was used six times on five patients for lesions averaging a distance of 8 cm from 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) with pathologies ranging from poorly to well-differentiated adenocarcinoma. Staging included 12 T1 lesions (46%), 10 T2 lesions (38%), and four T3 lesions (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 (T1 and T2 lesions) and recurrence was in the form of distant metastasis in two patients (two T3 lesions). Three of the recurrences occurred in patients with T3 lesions (three of four; 75%), two occurred in a patient with a T2 lesion (two of 10; 20%), and one occurred in a patient with a T1 lesion (one of 12; 8%). There were no cancer-related deaths during the study period. Twenty-six premalignant lesions (adenomatous polyps) and four benign lesions were excised (25 transanal/five trans-sacral). Local recurrence occurred 10 times with an average follow-up of 1.8 years. In conclusion local excision of certain rectal cancers is an acceptable alternative in the treatment of these malignancies.