Local excision as an option in the treatment of low rectal carcinoma

Local excision (LE) may offer an ideal method, instead of standard abdominoperineal excision (APE), for the treatment of low rectal carcinomas, if strict selection criterias are followed. The aim of this study was to evaluate the results after LE and APE, and further compare these two methods.

Thirty-three consecutive patients initially operated on by LE and 83 consecutive patients with radical APE made for tumours in Dukes' stages A to C were reviewed retrospectively.

The methods did not differ in terms of postoperative mortality and complications, 0/33 versus 1/83 (1%) and 9/33 (27%) versus 32/83 (39%), respectively. Five LEs were palliative and in 23 of the 28 patients, operated on with curative intent, LE alone was considered potentially curative. Local recurrence developed in four (18%) of the 22 patients followed up after curative LEs (14 had a T1 and eight a T2 tumour). In a comparable group of Dukes' stage A tumours, four of the 20 APE patients developed local recurrence. The longterm outcome of patients after LE and APE did not differ in terms of local-recurrence-free survival (80% versus 76%), cancer-specific survival (100% versus 90%) and overall survival (69% versus 76%) at five years, respectively. In conclusion, LE saved the anal continence in properly selected patients with low rectal carcinoma confined to the rectal wall without compromising their outcome. Large prospective series of LEs, however, are needed to assess the importance of factors suggested to increase the risk of local recurrence.