title: Outcomes of local excision for early rectal cancer: a 6-year experience from the largest university hospital in Thailand.
abstract: BACKGROUND
  This study aimed to determine clinical outcomes of local excision for early rectal cancer from a University Hospital in Thailand.
  
  
  METHODS
  We performed a retrospective review of 22 consecutive patients undergoing local excision for early rectal cancer (clinical and radiological T1/T2) from 2005-2010 at the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. Data were collected from patients' medical records, including demographic and clinical characteristics, pathological report and surgical outcomes.
  
  
  RESULTS
  This study included 10 males and 12 females, with average age of 68 years. Nineteen patients (86%) underwent transanal excision and the others had trans-sacral excision. Median operative time was 45 minutes. Postoperative complications occurred in 2 patients (9%); 1 fecal fistula and 1 wound infection following trans-sacral excision. There was no 30-day postoperative mortality. Median hospital stay was 5 days. Pathological reports revealed T1 lesion in 12 cases (55%), T2 lesion in 8 cases (36%) and T3 lesion in 2 cases (9%). Eight patients received additional treatment; one re-do transanal excision, two proctectomies, and five adjuvant chemoradiation. During the median follow-up period of 25 months, local recurrence was detected in 4 patients (18%); two cases of T2 lesions with close or positive margins, and two cases of T3 lesions. Three patients with local recurrence underwent salvage abdominoperineal resection. No local recurrence was found in T1/T2 lesions with free surgical margins.
  
  
  CONCLUSIONS
  Local excision is a feasible and acceptable alternative to radical resection only in early rectal cancer with free resection margins and favorable histopathology.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand E-mail : bolloon@hotmail.com.
authors.forename: Varut
authors.initials: V
authors.lastname: Lohsiriwat
authors.forename: Worabhong
authors.initials: W
authors.lastname: Anubhonganant
authors.forename: Siriluck
authors.initials: S
authors.lastname: Prapasrivorakul
authors.forename: Cherdsak
authors.initials: C
authors.lastname: Iramaneerat
authors.forename: Woramin
authors.initials: W
authors.lastname: Riansuwan
authors.forename: Wiroon
authors.initials: W
authors.lastname: Boonnuch
authors.forename: Darin
authors.initials: D
authors.lastname: Lohsiriwat
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant / Q000706:statistics & numerical data; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures; D061345:Early Medical Intervention; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013785:Thailand; D016896:Treatment Outcome