Local excision of rectal cancer: report of a technique and results

A technique for the local treatment of rectal cancer was performed in 29 patients who satisfied the criteria for local treatment. Four patients were classified as Dukes' stage A and 25 were stage B. Local treatment was performed by either direct excision or anorectal mobilization. The former was carried out in 13 patients in whom the tumor was located less than 7 cm from the dentate line. Excision after anorectal mobilization was performed in 16 patients with tumors located more than 7 cm from the dentate line. Patients were followed up for 5 to 10 years. They had normal rectal function after operation with normalization of rectal pressure and myoelectric activity of sphincteric muscles. Twenty four patients are alive and tumor-free. The five failures were Dukes' B category; four (30%) treated by direct excision and one (6%) by anorectal mobilization. They were subjected to a second, combined excision operation of the rectum: two patients died of distant metastasis and three are alive and tumor-free. The study showed that 12% of Dukes' B category patients had preoperative nodal deposits which escaped detection. Direct excision, owing to its high incidence of recurrence, should be restricted to Dukes' A category tumors, when the upper tumor edge is less than 7 cm from the dentate line. Otherwise, and with all Dukes' B category tumors, the anorectal mobilization operation is preferable.