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Results of local excision for rectal carcinoma
1Department of Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Que.
Objective:
To determine the results peranal excision for rectal carcinoma.
Design:
Retrospective case series.
Setting:
A university-affiliated hospital.
Patients:
Of 178 patients who presented for curative resection of rectal carcinoma between 1975 and 1993, 19 (10.7%) were deemed suitable for local excision. There were 10 men and 9 women with a mean age of 71.2 years. The follow-up ranged from 13 to 184 months.
Intervention:
Peranal excision.
Main Outcome Measures:
Histologic differentiation, gross morphology, depth of invasion and size of the carcinoma, adequacy of margins of excision, complications of operation, rates of recurrence, results of salvage therapy and 5-year survival.
Results:
There were no intraoperative complications. Postoperative complications included urinary retention (one patient) and bleeding (one patient). There were five local recurrences (26%). Salvage operations were performed in three (60%) patients and were successful in two of them. The 5-year cancer-specific survival rate was 82%. The recurrence rate was higher in patients with inadequate margins of excision and ulcerative lesions. Neither size nor grade of the carcinoma correlated with recurrence.
Conclusions:
Local excision of rectal carcinoma can be performed successfully in selected patients. Diligent follow-up is required, because up to 60% of local recurrences can be treated successfully.