Local excision of rectal carcinoma

Area of Science:

• Gastroenterology
• Surgical Oncology
• Oncology

Background:

• Local excision is a treatment option for rectal adenocarcinoma.
• Adjuvant therapy's role in improving outcomes after local excision is not fully established.

Purpose of the Study:

• To determine the recurrence rate after local excision of rectal adenocarcinoma.
• To evaluate the salvage rate following recurrence.
• To assess overall survival after local excision.

Main Methods:

• Retrospective review of 31 patients with rectal adenocarcinoma treated with local excision between 1990 and 1999.
• Exclusion of nine patients with advanced stage disease (T2 with vascular invasion or T3).
• Analysis of 22 patients (13 T1, 9 T2) who underwent transanal excision.

Main Results:

• Seven patients (32%) experienced local recurrence, all in those not receiving adjuvant chemoradiation.
• Four patients with T1 and three with T2 tumors recurred.
• All recurrences were salvaged by resection; four patients remain disease-free at a median follow-up of 19.5 months.

Conclusions:

• Local excision without adjuvant therapy results in an unacceptably high local recurrence rate for rectal adenocarcinoma.
• While salvage resection can be successful, long-term outcomes are uncertain.
• Adjuvant chemoradiation appears to decrease recurrence rates and may become a standard treatment adjunct.