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Local excision of rectal carcinoma
R A Graham1, L Garnsey, J M Jessup
1Department of Surgery, New England Medical Center, Boston, Massachusetts 02111.
American Journal of Surgery
|September 1, 1990
Summary
Local excision offers comparable survival and recurrence rates to abdominoperineal resection for early rectal cancer. Careful patient selection is key to achieving these favorable outcomes with reduced morbidity.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Gastrointestinal Pathology
Background:
- Local excision is a treatment option for invasive rectal carcinoma.
- Abdominoperineal resection (APR) is a traditional treatment with significant morbidity.
Purpose of the Study:
- To evaluate the efficacy of local excision for invasive rectal carcinoma.
- To compare outcomes of local excision with historical controls treated with APR.
- To identify clinicopathologic factors predicting outcomes after local excision.
Main Methods:
- Systematic review of 16 published series on local excision for rectal cancer.
- Analysis of patient survival, local recurrence, and treatment outcomes.
- Correlation of pathologic features (margins, histology, invasion depth, tumor size) with patient outcomes.
Main Results:
- Ninety-four percent of tumors were T1/T2 without regional metastases.
- Five-year cancer-specific survival was 89% with local excision.
- Local recurrence occurred in 19%, with over half successfully treated with salvage surgery.
- Positive margins, poor differentiation, and deeper invasion correlated with worse outcomes.
- Tumor size >3 cm was not a significant prognostic factor.
Conclusions:
- Local excision provides comparable survival and recurrence rates to APR for selected rectal cancer patients.
- Adherence to strict patient selection criteria is crucial for successful local excision.
- Local excision offers reduced morbidity and operative mortality compared to APR.