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Long-term results of local excision for T1 rectal carcinoma: the experience of two colorectal units

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Abstract

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.

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References

  1. Lee W, Lee D, Choi S, Chun H (2003) Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer. Surg Endosc 17:1283–1287

    Article  PubMed  CAS  Google Scholar 

  2. Hershman MJ, Myint AS, Makin CA (2003) Multi-modality approach in curative local treatment of early rectal carcinomas. Colorectal Dis 5:445–450

    Article  PubMed  CAS  Google Scholar 

  3. Sengupta S, Tjandra JJ (2001) Local excision of rectal cancer: what is the evidence? Dis Colon Rectum 44:1345–1361

    Article  PubMed  CAS  Google Scholar 

  4. Kudo S, Soga J, Yamamoto M, Koyama S, Muto T (1984) Treatment of colorectal sm- carcinomas (in Japanese with English abstract). Stomach Intest 19:1349–1355

    Google Scholar 

  5. Endreseth BH, Myrvold HE, Romundstad P, Bjerkeset T, Wibe A (2005) Transanal excision vs. major surgery for T1 rectal cancer. Dis Colon Rectum 48:1380–1388

    Article  PubMed  Google Scholar 

  6. Bentrem DJ, Okabe S, Wong WO et al (2005) T1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg 242:472–477

    PubMed  Google Scholar 

  7. Hahnloser D, Wolff BG, Larson DW, Ping J, Nivatvongs S (2005) Immediate radical resection after local excision of rectal cancer: an oncologic compromise? Dis Colon Rectum 48:429–437

    Article  PubMed  Google Scholar 

  8. Beynon J, Mortensen NJ, Foy DM et al (1986) Pre-operative assessment of local invasion in rectal cancer: digital examination, endoluminal sonography or computed tomography? Br J Surg 73:1015–1017

    Article  PubMed  CAS  Google Scholar 

  9. Mackay SG, Pager CK, Joseph D, Stewart PJ, Solomon MJ (2003) Assessment of the accuracy of transrectal ultrasonography in anorectal neoplasia. Br J Surg 90:346–350

    Article  PubMed  CAS  Google Scholar 

  10. Brown G, Radcliffe AG, Newcombe RG et al (2003) Preoperative assessment of prognostic factors in rectal cancer using high- resolution magnetic resonance imaging. Br J Surg 90:355–364

    Article  PubMed  CAS  Google Scholar 

  11. Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff RD, Rothenberger DA (2000) Local excision of rectal cancer without adjuvant therapy. A word of caution. Ann of Surg 231:345–351

    Article  CAS  Google Scholar 

  12. Madbouly KM, Remzi FH, Erkek BA et al (2005) Recurrence after transanal excision of T1 rectal cancer: should we be concerned? Dis Colon Rectum 48:711–721

    Article  PubMed  Google Scholar 

  13. Buess G, Kimpfmuller K, Ibald R, Heintz A, Junginger T (1988) Clinical results of transanal endoscopic microsurgery. Surg Endosc 2:245–250

    Article  PubMed  CAS  Google Scholar 

  14. Demartines N, von Flue MO, Harder FH (2001) Transanal endoscopic microsurgical excision of rectal tumors: indications and results. World J Surg 25:870–875

    Article  PubMed  CAS  Google Scholar 

  15. Floyd ND, Saclarides TJ (2006) Transanal endoscopic microsurgical resection of pT1 rectal tumors. Dis Colon Rectum 49:164–168

    Article  PubMed  Google Scholar 

  16. Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48:270–284

    Article  PubMed  Google Scholar 

  17. Maslekar S, Pillinger SH, Monson JB (2007) Transanal endoscopic microsurgery for carcinoma of the rectum. Surg Endosc 21:97–102

    Article  PubMed  CAS  Google Scholar 

  18. Stipa F, Bursa A, Lucandri G et al (2006) Outcomes for early rectal cancer managed with transanal endoscopic microsurgery: a 5 year follow-up study. Surg Endosc 20:541–545

    Article  PubMed  CAS  Google Scholar 

  19. Greenberg JA, Shibata D, Herndon JE II, Steele GD, Mayer R, Bleday R (2008) Local excision of distal rectal cancer: an update of cancer and leukemia group B 8984. Dis Colon Rectum 51:1185–1194

    Article  PubMed  Google Scholar 

  20. Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR (2002) Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 45:200–206

    Article  PubMed  Google Scholar 

  21. Blumberg D, Paty PB, Guillem JG et al (1999) All patients with small intramural rectal cancers are at risk for lymph node metastasis. Dis Colon Rectum 42:881–885

    Article  PubMed  CAS  Google Scholar 

  22. Nivatvongs S (2000) Surgical management of early colorectal cancer. World J Surg 24:1052–1055

    Article  PubMed  CAS  Google Scholar 

  23. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguillar J (2000) Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 43:1064–1071

    Article  PubMed  CAS  Google Scholar 

  24. Chakravarti A, Compton CC, Shellito PC et al (1999) Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg 230:49–54

    Article  PubMed  CAS  Google Scholar 

  25. Masaki T, Sugiyama M, Matusoka H et al (2003) Clinical utility of grading criteria for submucosal invasion in prognosis of T1 colorectal cancer. J Gastroenterol 38:37–44

    Article  PubMed  Google Scholar 

  26. Kitajima K, Fujimori T, Fujii S et al (2004) Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol 39:534–543

    Article  PubMed  Google Scholar 

  27. Nascimbeni R, Nivatvongs S, Larson DR, Burgart LJ (2004) Long-term survival after local excision for T1 carcinoma of the rectum. Dis Colon Rectum 47:1773–1779

    Article  PubMed  Google Scholar 

  28. Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguílar J (2002) Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum 45:875–879

    Article  PubMed  Google Scholar 

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Acknowledgment

Esther Eshkol is thanked for editorial assistance.

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Authors and Affiliations

  1. Colorectal Unit, Department of Surgery A, Rambam Medical Center, Technion School of Medicine, Haifa, Israel

    Alexander Lebedyev, Michael Krausz & Simon D. Duek

  2. Proctology Unit, Department of Surgery B, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weitzman Street, 64239, Tel Aviv, Israel

    Alexander Lebedyev, Hagit Tulchinsky, Micha Rabau & Joseph M. Klausner

Authors
  1. Alexander Lebedyev
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  2. Hagit Tulchinsky
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  3. Micha Rabau
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  4. Joseph M. Klausner
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  5. Michael Krausz
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  6. Simon D. Duek
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Corresponding author

Correspondence to Hagit Tulchinsky.

Additional information

A. Lebedyev and H. Tulchinsky contributed equally to this study.

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Lebedyev, A., Tulchinsky, H., Rabau, M. et al. Long-term results of local excision for T1 rectal carcinoma: the experience of two colorectal units. Tech Coloproctol 13, 231–236 (2009). https://doi.org/10.1007/s10151-009-0521-3

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  • DOI: https://doi.org/10.1007/s10151-009-0521-3

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