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Prospective evaluation of local excision for small rectal cancers
R Bleday1, E Breen, J M Jessup
1Department of Surgery, Deaconess Hospital, and Harvard Medical School, Boston, Massachusetts, USA.
Diseases of the Colon and Rectum
|April 1, 1997
Summary
Local excision is a safe option for small rectal cancers, showing low recurrence rates of 8%. Further therapy is advised for positive margins or lymphatic invasion.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Retrospective studies dominate local excision data for rectal cancer.
- Prospective data is needed to evaluate outcomes for specific techniques and patient groups.
Purpose of the Study:
- To prospectively evaluate the outcomes of local excision for rectal cancer.
- To assess the efficacy of multimodality therapy in conjunction with local excision for advanced lesions.
Main Methods:
- A prospective registry was used to track patients eligible for local excision.
- Inclusion criteria: lesions <4cm, <10cm from dentate line, no distant metastases.
- Transanal, transsphincteric, or transcoccygeal excision techniques were employed, with adjuvant chemoradiation for T2/T3 lesions.
Main Results:
- 48 patients were prospectively followed; mean follow-up was 40.5 months.
- Pathology revealed 1 Tis, 21 T1, 21 T2, and 5 T3 cancers.
- Overall mortality was 4%, with an 8% local or distant recurrence rate, linked to positive margins or lymphatic invasion.
Conclusions:
- Local excision is a viable, low-morbidity option for select small rectal cancers.
- Positive margins or lymphatic invasion necessitate consideration for further treatment, even in T1 lesions.
- Adjuvant chemoradiation appears beneficial for T2 or T3 rectal cancers treated with local excision.