Surgery of rectal tumors

Area of Science:

• Oncology
• Surgical Gastroenterology
• Rectal Cancer Treatment

Background:

• This study reviews 30 years of experience in treating 690 rectal carcinoma patients, comparing conventional surgery (602 patients) with local excision (88 patients).
• Conventional surgery included anterior resection (53%) and abdominoperineal resection (47%), with radical resection in 89.6% of cases.
• Local excision was used for smaller rectal tumors (<3 cm), often in the lower or middle rectum, with 60% receiving neoadjuvant/adjuvant therapy.

Discussion:

• Anterior resection is recommended for upper and middle rectal tumors, while abdominoperineal resection (Miles operation) is reserved for tumors within 5 cm of the anal verge.
• Local excision is effective for small, rectal wall-confined tumors, especially when combined with preoperative chemoradiation for tumors involving the muscular layer.
• No significant difference in outcomes was found between anterior resection and Miles operation in the conventional surgery group.

Key Insights:

• Conventional surgery had a 4% mortality and 33% morbidity, with a 17% local recurrence rate. 5- and 10-year survival rates were 53% and 43%, respectively.
• Local excision demonstrated low toxicity (16% morbidity, no mortality) and promising results for early-stage rectal cancers, with recurrence rates related to tumor stage.
• Complete response was observed in 28% of T2 patients undergoing local excision with neoadjuvant treatment and negative margins.

Outlook:

• Further research should focus on optimizing neoadjuvant and adjuvant therapies for rectal cancer to improve survival and reduce recurrence rates.
• Advancements in endoluminal surgery and stapling devices continue to enhance surgical outcomes for rectal carcinoma.
• Personalized treatment strategies based on tumor stage, location, and patient factors are crucial for effective rectal cancer management.