Transanal excision of early rectal carcinoma-review of a personal series

Transanal excision of small rectal tumours is a relatively minor procedure that is potentially curable and can be employed in selected cases of rectal cancer. The outcome of 22 cases treated by local excision was reviewed. This represented 9% of patients treated for rectal cancer over the study period. All patients had a transanal excision with curative intent and included three patients who were medically unfit for a major procedure. Follow up was for a minimum of 5 years or until death if this was earlier. The mean age was 65.7 years with 10 males and 12 females. The 5-year recurrence rate was 27% (five of 22). The crude 5-year survival for curative resection was 77%. Of the 22 local excisions, 10 were T1 and 12 were T2. The size of tumour varied from 0.5 cm to 3.5 cm. Eight were well differentiated, 10 moderate and two poorly differentiated. Two of the earlier cases in the series were unclassified. There were six recurrences, all of which were extraluminal. Three recurrences were in less than 3 years (early recurrence) and three beyond this time. Of the recurrences, one presented with liver metastases within 2 months of surgery, one was unfit for a major procedure and subsequently died of a myocardial infarction. The remaining patients with recurrences had salvage surgery. Three are still alive and one died over 5 years after a local excision, with the presence of recurrence. All recurrences were of T2 stage, with moderate (n=5) or poor differentiation (n=1). Three of the six tumours measuring > 3 cm recurred compared with three of the 16 tumours between 0.5 cm and 3 cm. Analysis of these cases demonstrates that local resection of small rectal tumours can give good results and salvage operation is possible in the event of recurrence. Long term follow up is recommended because of risks of late recurrence. The best prognosis group appears to be with the well-differentiated T1 tumours with no involved margins.