[Long-term outcome of local excision for lower rectal cancer]

In many practical cases, we cannot perform further surgical treatment for patients with T1 lower rectal cancer after local excision due to the patient's desire to avoid abdominoperineal resection. We reviewed the outcome of 15 patients in which local excision was performed for T1 lower rectal cancer from 2001 to 2009. The cases were classified into 3 groups [SM1 (n=3), SM2 (n=11), and SM3 (n=1)] by dividing the submucosal layer equally. In the initial operation, the round margins of all resected specimens were negative for cancer cells. We performed only 1 additional bowel resection after initial local excision for the SM3 case. The specimen removed by ultra-low anterior resection revealed lymph node metastasis in the mesorectum. Among the SM2 cases, recurrence occurred in only 1 patient, and ultra-low anterior resection was performed after the diagnosis of recurrence. Even though patients who had cancer with SM2 invasion did not undergo further bowel resection due to having other cancers or comorbidities or because of personal preference, there have been no other recurrences.