[Curative local excision of colorectal cancer. A prospective study]

The importance of local treatment for early colorectal cancer is apparent because of increasing endoscopical activity for diagnostic purposes and screening. Curative local treatment was attempted in 63 patients with polypoid, mobile tumours thought to be within the bowel wall and without palpable lymph nodes in the perirectal tissue. Tumours more than 3 cm in diameter were excluded, unless they were pedunculated or were believed to be adenomas with carcinoma. Removal was effected by polypectomy, piecemeal removal, peranal excision, posterior rectotomy or colotomy. Complications were few, and hospitalization was shorter than after conventional surgery, but one patient died from treatment. More extensive surgery followed in 12 patients, in whom cancer remained in the resection margin or where this could not be excluded. However, seven of the 12 patients had no residual cancer tissue. Survival without recurrence was longer in patients with tumours below 3 cm in diameter. Recurrence was seen in nine patients, but not in those with cancer limited to head and the stalk of pedunculated tumours and not with cancer limited to the luminal part of submucosa, regardless of shape of tumour. Adenoma in continuity with cancer did not influence survival significantly, but synchronous adenomas in other parts tended to increase recurrence-free survival. Local treatment is satisfactory in most patient with cancer within pedunculated polyps and in some with cancer in sessile polypopid tumours. Criteria of selection are not optimal and the use of endoluminal ultrasound examinations must be evaluated in prospective trials. At present, conventional surgery should be used when cancer in the resection margin cannot be excluded, when cancer is present in the deeper layers of muscularis propria and in patients with poorly differentiated cancers.