[Value of local surgical therapy for rectal cancer. A literature analysis]

Local excision of pT(1) rectal cancer is recognized as curative treatment, whereas the indication is not clarified for pT(2)-tumours. In addition the prognostic histological analysis criteria and the influence of adjuvant and neoadjuvant measures are open.

Starting form the publication date 1990 investigations on the local excision, with and without adjuvant or neoadjuvant therapy, were included in our literature search and analysed if they comprised at least 30 patients and a follow up of at least 24 months. We studied the assessment criteria local recurrence, survival rate, histological grading, and the conditions of resection margins.

After complete resection of "low grade" rectal cancers local recurrences are expected for the pT(1)-category of mean 8 % and for pT(2)-tumours of mean 22%. Poor differentiated pT(1)-tumours exhibit after complete resection over 18 % and after incomplete, despite adjuvant radio (chemo)-therapy, up to 26% recurrences. For pT(2) "high grade" tumours in mean 50% local recurrences and for pT(2) "low grade" tumours after complete resection and adjuvant irradiation in mean 6% have to be expected. Adjuvant measures cannot lower the local recurrence rate for pT(2) tumours after incomplete resection under 20%.

Local excision with clear margins represents for pT(1) "low grade" cancer an adequate therapy. Further prospective investigations are necessary to clarify whether adjuvant radio (chemo)-therapy represents a curative therapeutic option for pT(2) "low grade" tumours after complete resection.