Surgical treatment of low-lying carcinoma of the rectum

The standard operative treatment of low-lying rectal cancer has been abdominoperineal resection. In the elderly patient, this treatment has significant risk. One-fourth of the patients had major complications and another one-fourth had minor complications. The operative mortality was 6.8 per cent for patients 65 years of age and over and 7.7 per cent for patients 70 years old and over. Patients with metastatic disease at the time of diagnosis had a dismal prognosis despite treatment with abdominoperineal resection. Postoperative pelvic radiotherapy should help reduce pelvic recurrence. Generally, patients with tumors less than 5 cm in diameter and less than 5 cm from the dentate line should be considered for initial transanal excision. It appears that very good local tumor control can be achieved by transanal excision for tumors confined to the bowel wall. Only 6.9 per cent of patients with tumors confined to the bowel wall had lymph node metastasis. The low risk of occult lymph node metastasis from tumors confined to the bowel wall is offset by the operative risk of abdominoperineal resection. Further evaluation of transanal excision of selected rectal cancers is indicated. Patients with villous adenomas with superficial carcinoma can be adequately treated repetitively with transanal local excision. In this case, there was a 50 per cent local recurrence rate. Local recurrence occurred in some patients five or more years after the initial treatment, thus emphasizing the need for prolonged close proctoscopic follow-up.