Local excision and postoperative radiation therapy for rectal cancer

We report the results of 22 patients with localized, mobile, resectable rectal cancer treated with local excision and postoperative radiation therapy.

Margins were negative in 21 patients and unassessable in 1. The median follow-up was 37 months (range: 5-73 months). The median tumor size was 3.0 cm (range: 1-6.2 cm). Full-thickness local excisions were performed in 21 patients: transanal, 11; transsphincteric, 2; and posterior proctotomy (Kraske), 8. All margins were inked and were microscopically negative in 21. One patient had a transanal snare excision of a T1 polyp. Postoperatively patients received 4,500-4,950 cGy (median: 4,680 cGy) whole pelvis, and in 15 this was followed by a conedown to 360-1,000 cGy (median: 360 cGy).

The 4-year actuarial survival was 79% and the 4-year actuarial colostomy-free survival was 73%. The incidence of local failure was 18% and increased with T stage: T1: 0/4 (0%); T2: 2/12 (17%); and T3: 2/6 (33%). Four patients developed local failure at 6, 10, 15, and 21 months. Of the four, three underwent salvage APR and were locally controlled at 6, 33, and 58 months following salvage surgery. The incidence of abdominal failure was 18% and distant failure was 18%. Of the 15 eligible patients, 14 (93%) had good or excellent sphincter function.

The results of local excision and postoperative radiation therapy are encouraging; however, more experience is needed to determine if this approach ultimately has similar local control and survival rates as standard surgery.