Local excision of stratified T1 rectal cancer.
BACKGROUND
Local excision has been accepted therapy for T1 rectal cancers. A recent study demonstrated that primary tumors with deeper submucosal invasion were associated with a higher rate of lymph node metastases than those with shallow invasion. Our aim was to determine the effect of the depth of submucosal penetration on recurrence and mortality rates following transrectal excision of T1 tumors.


METHODS
This was a 34-year retrospective review of patients who had transrectal excision with clear margins for T1 rectal cancer. Tumors were stratified into submucosal (SM) levels, and recurrence and mortality rates were determined.


RESULTS
Of 101 patients with T1 rectal cancer undergoing local excision, 31 had a full-thickness transrectal excision. Eight (26%) of the 31 patients developed a local recurrence, 2 of whom had both a local and distant recurrence. Four patients (13%) died from metastatic rectal cancer.


CONCLUSIONS
The recurrence rate for transrectal excision of T1 rectal cancer is high. It may be beneficial for patients with early rectal cancer to have postoperative chemoradiation therapy or a more radical surgical procedure.
Department of Colon and Rectal Surgery, Spectrum Health-Blodgett Campus, Grand Rapids, MI, USA. kellywir@aol.com
Kelly
K
Wirsing
Shauna
S
Lorenzo-Rivero
Martin
M
Luchtefeld
Donald
D
Kim
Thomas
T
Monroe
Houssam
H
Attal
Rebecca
R
Hoedema
D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome