Local excision of rectal cancer through windowed specula: long-term results

Transanal local excision of rectal cancer has been advocated as a curative option in patients with early rectal cancer and for patients unsuitable for radical surgery. We report our long-term experience with an easy-to-use and inexpensive technique based on windowed specula. From 1982 to 1994, 137 patients with rectal cancer were treated by local excision with curative intention. An R0 resection was possible in 74% of all patients and in 80% of the patients with a tumor surface of less than 9 cm2. Ninety patients with a follow-up of more than 3 years (T1: n = 50, T2: n = 30, T3: n = 14) were evaluated for survival. Seventy-four of these 90 patients are currently alive. The cause of death is known for all 16 deceased patients. In 4, death was tumor-related; 3 of these patients had a component of local failure. In 6 of 8 patients with local recurrence, a radical reresection was possible. The rate of recurrence increased with T category and with tumor grade. There has been one recurrence in a patient with a T1G1 cancer. The instrumentation enables adequate local excision of rectal cancers of less than 9 cm2 surface area. In this group of patients including a considerable number with T2 and T3 cancers, only 3 died of tumor-related causes with a component of local failure, which compares well with mortality rates above 4% for abdominoperineal excision. Comparison with international data on radical surgery shows that the overall survival is not reduced by local transanal excision for early rectal cancer.