Results at St Mark’s Hospital
Over the years, about 5% of rectal cancers seen at St Mark’s have been treated by local excision. We have adopted the policy of clinical assessment, followed in recent years by endoluminal ultrasonic examination to identify the following features: tumour up to 3 cm in diameter, confined to the rectal wall, and not poorly differentiated on histological examination of a preoperative biopsy. In addition, the lesion has to be accessible to surgical excision. Other than in particularly poor-risk patients, we have felt strongly that local excision should be an alternative to total excision of the rectum and should not be used where an anterior resection can be performed. With regard to technique, we have tried to use an endoanal approach and have for some long time given up posterior trans-sacral procedures. The reason for this is that we want to avoid opening up the anatomical plane surrounding the rectum in order to prevent implantation of cancer cells in the extra-rectal tissues. The other important aspect of technique has been the removal of a full thickness disc of rectal wall with some of the surrounding extra-rectal fat. Submucosal excision is not appropriate to the management of carcinoma.
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