Long-term results of local excision for T1 rectal carcinoma: the experience of two colorectal units.
BACKGROUND
Local excision for early rectal cancer has low morbidity and good functional results. Its use is limited by the inability to assess regional lymph nodes and by the uncertainty of oncologic outcome.


METHODS
We conducted a retrospective chart review of all patients who underwent local excision of early rectal cancer in two colorectal units between 1995 and 2007. The retrieved and analyzed data were patient age and gender, tumor size, tumor distance from the anal verge, tumor differentiation, and additional treatment.


RESULTS
There were 42 patients with T1 rectal cancer: 24 underwent transanal endoscopic microsurgery and 18 had a transanal excision. The surgical margins were free of tumor in 39 patients (93%), they were involved by tumor in one (2%) and margin status was unclear in two (5%). Seven patients (16%) had postoperative complications. There was no postoperative mortality. The mean hospital stay was 67 h. Thirty-nine patients (93%) were followed up for 57 months (mean). Two patients had local recurrence, at 7 and 41 months post-surgery. They had a tumor that invaded into the lower third of the submucosa, sm3. Both received chemoradiotherapy, and underwent an abdominoperineal resection and a low anterior resection. One of them died of metastatic disease 13 months later and the other is alive with no evidence of disease. Another two patients had salvage low anterior resection, one for suspected local recurrence and one for lymphovascular invasion: the specimens were tumor free. Six patients died of unrelated causes.


CONCLUSIONS
Local excision of early rectal cancer is a feasible and acceptable alternative to radical resection. It has low complication and recurrence rates and a short postoperative hospital stay.
Lebedyev
Alexander
A
Department of Surgery A, Rambam Medical Center, Technion School of Medicine, Haifa, Israel.
Tulchinsky
Hagit
H
Rabau
Micha
M
Klausner
Joseph M
JM
Krausz
Michael
M
Duek
Simon D
SD
D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000473:pathology / Q000601:surgery; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007557:Israel; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000503:physiopathology; D011336:Probability; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome