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Immediate Radical Resection After Local Excision of Rectal Cancer: An Oncologic Compromise?

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Diseases of the Colon & Rectum

PURPOSE

Local excision for early-staged rectal cancers is controversial. Preoperative understaging is not uncommon and radical resection after local resection may be needed for a curative treatment. The aim of this study was to determine the frequency and outcome of radical resection (within 30 days) after local excision for rectal adenocarcinoma.

METHODS

All locally excised rectal cancers (curative intent) that required radical surgery within 30 days were reviewed (1980–2000). T2–3N0–1 stage cancers were each matched to three primary radical surgery controls for stage, age (±5 years), gender, date (±1 years), and type (abdominoperineal resection or low anterior resection) of operation. T1N0–1 cancers were compared with stage-matched rectal cancers treated by either primary radical surgery (n = 78) or local excision alone (n = 77).

RESULTS

Fifty-two locally excised rectal adenocarcinomas (29 transanal and 23 polypectomies) were followed by radical surgery (24 abdominoperineal resection and 28 low anterior resection) within 7 (range, 1–29) days. Radical surgery was performed because of a cancerous polyp (n = 42), positive margins (5), lymphovascular invasion (3), and T3-staged cancer (2). Twelve of 52 cancers (23 percent) were found to have nodal involvement and 15 of 52 (29 percent) showed residual cancer in the resected specimen. The T2–3N0–1 stage controls were well matched. No significant difference in tumor location, size, adjuvant therapy, or length of follow-up was noted. Local and distant recurrence occurred in 2 of 4 T2–3N1 tumors and in 2 of 11 T2–3N0 cancers and were comparable to the matched controls, as was survival, with the exception of shorter survival in T3N1 cases, but numbers were too small for a definitive conclusion. Length of follow-up was not different. For T1 cancers, the controls were also comparable regarding patient and tumor demographics and adjuvant therapy. Nodal involvement was 21 percent in T1 study cases and 15 percent in T1 primary radical-surgery controls, with a trend toward location in the lower third of the rectum in both groups (58 percent and 50 percent, respectively). Local recurrence rates were 3 percent in the study group, 5 percent for patients undergoing primary radical surgery, and 8 percent for local excision alone. Distant metastasis (11 percent, 12 percent, and 13 percent, respectively) and overall five-year survival were also not significantly different (78 percent, 89 percent, and 73 percent, respectively).

CONCLUSIONS

Nodal involvement in attempted locally excised rectal cancers is not uncommon. Local excision of rectal tumors followed by radical surgery within 30 days in cancer patients does not compromise outcome compared with primary radical surgery. Even after radical surgery for superficial T1 rectal cancers, recurrence rates are not insignificant. Future improvements in preoperative staging may be helpful in selecting tumors for local excision only.

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REFERENCES

  1. RJ Heald BJ Moran RD Ryall R Sexton JK MacFarlane (1998) ArticleTitleRectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997 Arch Surg 133 894–9 Occurrence Handle10.1001/archsurg.133.8.894 Occurrence Handle1:STN:280:DyaK1cznsFOrsQ%3D%3D Occurrence Handle9711965

    Article  CAS  PubMed  Google Scholar 

  2. A Heintz M Morschel T Junginger (1998) ArticleTitleComparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum Surg Endosc 12 1145–8 Occurrence Handle1:STN:280:DyaK1czosVClsQ%3D%3D Occurrence Handle9716769

    CAS  PubMed  Google Scholar 

  3. CG Willett CC Compton PC Shellito JT Efird (1994) ArticleTitleSelection factors for local excision or abdominoperineal resection of early stage rectal cancer Cancer 73 2716–20 Occurrence Handle1:STN:280:DyaK2c3ltFOjug%3D%3D Occurrence Handle8194011

    CAS  PubMed  Google Scholar 

  4. J Garcia-Aguilar A Mellgren P Sirivongs D Buie RD Madoff DA Rothenberger (2000) ArticleTitleLocal excision of rectal cancer without adjuvant therapy: a word of caution Ann Surg 231 345–51 Occurrence Handle10.1097/00000658-200003000-00007 Occurrence Handle1:STN:280:DC%2BD3c7nslWjuw%3D%3D Occurrence Handle10714627

    Article  CAS  PubMed  Google Scholar 

  5. PB Paty GM Nash P Baron et al. (2002) ArticleTitleLong-term results of local excision for rectal cancer Ann Surg 236 522–9 Occurrence Handle10.1097/00000658-200210000-00015 Occurrence Handle12368681

    Article  PubMed  Google Scholar 

  6. SG Mackay CK Pager D Joseph PJ Stewart MJ Solomon (2003) ArticleTitleAssessment of the accuracy of transrectal ultrasonography in anorectal neoplasia Br J Surg 90 346–50 Occurrence Handle1:STN:280:DC%2BD3s%2Fot1OitA%3D%3D Occurrence Handle12594671

    CAS  PubMed  Google Scholar 

  7. GF Gualdi E Casciani A Guadalaxara C d’Orta E Polettini G Pappalardo (2000) ArticleTitleLocal staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings Dis Colon Rectum 43 338–45 Occurrence Handle1:STN:280:DC%2BD3c7psFamsQ%3D%3D Occurrence Handle10733115

    CAS  PubMed  Google Scholar 

  8. NK Kim MJ Kim JK Park SI Park JS Min (2000) ArticleTitlePreoperative staging of rectal cancer with MRI: accuracy and clinical usefulness Ann Surg Oncol 7 732–7 Occurrence Handle1:STN:280:DC%2BD3M7gsV2nsQ%3D%3D Occurrence Handle11129420

    CAS  PubMed  Google Scholar 

  9. S Nivatvongs JD Nicholson DA Rothenberger et al. (1980) ArticleTitleVillous adenomas of the rectum: the accuracy of clinical assessment Surgery 87 549–51 Occurrence Handle1:STN:280:DyaL3c7mvFCktg%3D%3D Occurrence Handle7368104

    CAS  PubMed  Google Scholar 

  10. S Galandiuk VW Fazio DG Jagelman et al. (1987) ArticleTitleVillous and tubulovillous adenomas of the colon and rectum. A retrospective review, 1964-1985 Am J Surg 153 41–7 Occurrence Handle1:STN:280:DyaL2s%2FpslOgtw%3D%3D Occurrence Handle3799891

    CAS  PubMed  Google Scholar 

  11. F Pigot D Bouchard M Mortaji et al. (2003) ArticleTitleLocal excision of large rectal villous adenomas: long-term results Dis Colon Rectum 46 1345–50 Occurrence Handle14530673

    PubMed  Google Scholar 

  12. S Nivatvongs (2002) ArticleTitleSurgical management of malignant colorectal polyps Surg Clin North Am 82 959–66 Occurrence Handle12507202

    PubMed  Google Scholar 

  13. R Nascimbeni LJ Burgart S Nivatvongs DR Larson (2002) ArticleTitleRisk of lymph node metastasis in T1 carcinoma of the colon and rectum Dis Colon Rectum 45 200–6 Occurrence Handle11852333

    PubMed  Google Scholar 

  14. BC Morson HJ Bussey S Samoorian (1977) ArticleTitlePolicy of local excision for early cancer of the colorectum Gut 18 1045–50 Occurrence Handle1:STN:280:DyaE1c7gslyqtQ%3D%3D Occurrence Handle606631

    CAS  PubMed  Google Scholar 

  15. GD Steele JE Herndon R Bleday et al. (1999) ArticleTitleSphincter-sparing treatment for distal rectal adenocarcinoma Ann Surg Oncol 6 433–41 Occurrence Handle10.1007/s10434-999-0433-5 Occurrence Handle10458680

    Article  PubMed  Google Scholar 

  16. RA Graham L Garnsey JM Jessup (1990) ArticleTitleLocal excision of rectal carcinoma Am J Surg 160 306–12 Occurrence Handle1:STN:280:DyaK3czmsFWmsw%3D%3D Occurrence Handle2203268

    CAS  PubMed  Google Scholar 

  17. PM Madsen O Braendstrup (1985) ArticleTitleCarcinoma recti. The predictive value of diagnostic biopsies for histologic grading Dis Colon Rectum 28 676–7 Occurrence Handle1:STN:280:DyaL28%2FivFyjug%3D%3D Occurrence Handle4053911

    CAS  PubMed  Google Scholar 

  18. A Chakravarti CC Compton PC Shellito et al. (1999) ArticleTitleLong-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation Ann Surg 230 49–54 Occurrence Handle10.1097/00000658-199907000-00008 Occurrence Handle1:STN:280:DyaK1MzisFKhsQ%3D%3D Occurrence Handle10400036

    Article  CAS  PubMed  Google Scholar 

  19. JP Lamont TM McCarty RD Digan R Jacobson P Tulanon WE Lichliter (2000) ArticleTitleShould locally excised T1 rectal cancer receive adjuvant chemoradiation? Am J Surg 180 402–5 Occurrence Handle1:STN:280:DC%2BD3M7lvVWrtA%3D%3D Occurrence Handle11182387

    CAS  PubMed  Google Scholar 

  20. D Blumberg PB Paty JG Guillem et al. (1999) ArticleTitleAll patients with small intramural rectal cancers are at risk for lymph node metastasis Dis Colon Rectum 42 881–5 Occurrence Handle1:STN:280:DyaK1Mzjslansw%3D%3D Occurrence Handle10411434

    CAS  PubMed  Google Scholar 

  21. S Sengupta JJ Tjandra (2001) ArticleTitleLocal excision of rectal cancer: what is the evidence? Dis Colon Rectum 44 1345–61 Occurrence Handle1:STN:280:DC%2BD3MrjsFWmsw%3D%3D Occurrence Handle11584215

    CAS  PubMed  Google Scholar 

  22. H Kwok IP Bissett GL Hill (2000) ArticleTitlePreoperative staging of rectal cancer Int J Colorectal Dis 15 9–20 Occurrence Handle1:STN:280:DC%2BD3c3islWmsQ%3D%3D Occurrence Handle10766086

    CAS  PubMed  Google Scholar 

  23. PL Baron WE Enker MF Zakowski C Urmacher (1995) ArticleTitleImmediate vs. salvage resection after local treatment for early rectal cancer Dis Colon Rectum 38 177–81 Occurrence Handle1:STN:280:DyaK2M7lsVSluw%3D%3D Occurrence Handle7851173

    CAS  PubMed  Google Scholar 

  24. MR Lock JK Ritchie PR Hawley (1993) ArticleTitleReappraisal of radical local excision for carcinoma of the rectum Br J Surg 80 928–9 Occurrence Handle1:STN:280:DyaK3sznvFyntQ%3D%3D Occurrence Handle8369942

    CAS  PubMed  Google Scholar 

  25. CM Friel JW Cromwell C Marra RD Madoff DA Rothenberger J Garcia-Aguilar (2002) ArticleTitleSalvage radical surgery after failed local excision for early rectal cancer Dis Colon Rectum 45 875–9 Occurrence Handle10.1007/s10350-004-6320-z Occurrence Handle12130873

    Article  PubMed  Google Scholar 

  26. D Hahnloser H Nelson LL Gunderson et al. (2003) ArticleTitleCurative potential of multimodality therapy for locally recurrent rectal cancer Ann Surg 237 502–8 Occurrence Handle12677146

    PubMed  Google Scholar 

  27. M Hunerbein (2003) ArticleTitleEndorectal ultrasound in rectal cancer Colorectal Dis 5 402–5 Occurrence Handle1:STN:280:DC%2BD3szovVegsQ%3D%3D Occurrence Handle12925070

    CAS  PubMed  Google Scholar 

  28. V Goh S Halligan CI Bartram (2004) ArticleTitleLocal radiological staging of rectal cancer Clin Radiol 59 215–26 Occurrence Handle1:STN:280:DC%2BD2c7ktlahtg%3D%3D Occurrence Handle15037133

    CAS  PubMed  Google Scholar 

  29. CJ Kim TJ Yeatman D Coppola et al. (2001) ArticleTitleLocal excision of T2 and T3 rectal cancers after downstaging chemoradiation Ann Surg 234 352–8 Occurrence Handle10.1097/00000658-200109000-00009 Occurrence Handle1:STN:280:DC%2BD3MvotVylsA%3D%3D Occurrence Handle11524588

    Article  CAS  PubMed  Google Scholar 

  30. I Bedrosian MA Rodriguez-Bigas B Feig et al. (2004) ArticleTitlePredicting the node-negative mesorectum after preoperative chemoradiation for locally advanced rectal carcinoma J Gastrointest Surg 8 56–63 Occurrence Handle10.1016/j.gassur.2003.09.019 Occurrence Handle14746836

    Article  PubMed  Google Scholar 

  31. JJ Telford JR Saltzman KM Kuntz S Syngal (2004) ArticleTitleImpact of preoperative staging and chemoradiation versus postoperative chemoradiation on outcome in patients with rectal cancer: a decision analysis J Natl Cancer Inst 96 191–201 Occurrence Handle14759986 Occurrence Handle10.1093/jnci/djh026

    Article  PubMed  Google Scholar 

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Correspondence to Bruce G. Wolff M.D..

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D. Hahnloser’s current address is: Visceral and Transplantation Surgery, University Hospital Zurich, Switzerland.

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Hahnloser, D., Wolff, B., Larson, D. et al. Immediate Radical Resection After Local Excision of Rectal Cancer: An Oncologic Compromise?. Dis Colon Rectum 48, 429–437 (2005). https://doi.org/10.1007/s10350-004-0900-9

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  • DOI: https://doi.org/10.1007/s10350-004-0900-9

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