title: Evaluation of local excision for sessile-type lower rectal tumors.
abstract: OBJECTIVE
  A study was undertaken to evaluate the surgical morbidity and risk of recurrence in patients undergoing local excision for rectal carcinoma.
  
  
  METHODS
  Twenty patients with well or moderately differentiated lesions less than 6 cm in diameter, which were difficult to remove endoscopically but had no clinically involved regional nodes, were eligible for local excision.
  
  
  RESULTS
  The transanal approach was simple and had few complications. After posterior parasacral excision, 3 patients developed rectocutaneous fistulas, and 1 of them died. None of the 12 patients with cancer extension limited to the lesser depth of the submucosa died of rectal cancer. Among 8 patients with cancer invasive into the greater depth of the submucosa or deeper, 5 underwent additional radical resection, and regional lymph node metastasis was revealed in 2.
  
  
  CONCLUSIONS
  Transanal excision is suitable for curative resection of lower rectal tumors when the cancer extends only to the lesser depth of the submucosa. The procedure should be defined as a total excisional biopsy until the results of histologic examination are obtained.
authors.affiliation: Department of Surgery and Pathology, Tokyo Rosai Hospital, Japan. ishizaki-yoichi@mx3.ttcn.ne.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Ishizaki
authors.forename: Y
authors.initials: Y
authors.lastname: Takeda
authors.forename: T
authors.initials: T
authors.lastname: Miyahara
authors.forename: T
authors.initials: T
authors.lastname: Tokutome
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors