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Local Excision of Rectal Cancer

  • Peter A. Cataldo
Chapter

Abstract

The earliest surgery for rectal cancer involved local ­excision. Due to limitations in anesthesia, surgical instruments, ­operative techniques, and blood transfusions, transabdominal, radical resections were thought to be too risky. Local excision, however safe, was associated with high local recurrence rates and poor overall survival, perhaps due to patient selection and inability to remove peritumoral lymph nodes containing regional metastases. For these reasons, Sir ­Earnest Miles expanded the indications for abdominal–perineal resection1 (APR), originally described by Faget for perianal sepsis2 for the treatment of rectal cancer. He believed that excision of regional lymph nodes would improve overall cure rates. Miles theories were correct, but not without consequences, as seven of his original nine patients died from complications of surgery.1 Complication concerns following APR continue today with mortality rates ranging from 0 to 6.3%3,4 and complication rates as high as 61%.5 In addition, APR is associated with a high rate of sexual dysfunction (67%) and stoma related problems (66%).6 Finally, despite these complications and long-term functional consequences, some early rectal cancers recur despite radical surgery. The 5-year survival for Stage I rectal cancer following radical surgery is 73% as reported by the National Cancer Data Base.7

Notes

Acknowledgment.

A previous version of this chapter was authored by Ronald Bleday and Julio Garcia-Aguilar.

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Copyright information

© ASCRS (American Society of Colon and Rectal Surgeons) 2011

Authors and Affiliations

  • Peter A. Cataldo
    • 1
  1. 1.Department of SurgeryFletcher Allen HealthcareBurlingtonUSA

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