Early Rectal Cancer: Definition and Management

Emanuele Lezoche, Maddalena Baldarelli, Angelo De Sanctis, Giovanni Lezoche, Mario Guerrieri
2007 Digestive Diseases  
treated with transanal endoscopic microsurgery were similar to those reported in the literature after conventional surgery (total mesorectal excision). Colorectal cancer is the second most common cause of cancer deaths in the Western world. More than 35,000 new rectal cancers are diagnosed every year in the USA and 25% are stage I disease. Fewer than half of these cases are lesions confined to the mucosa and submucosa [1] . In the past the gold standard of treatment for all low rectal cancers
more » ... s anterior resection with coloanal or low rectal anastomosis and abdominoperinal resection. These procedures led to good results in terms of local recurrence and 5-year survival rate [1-4] . Unfortunately, resection of the rectum is a major surgery procedure associated with significant morbidity (7-68%), mortality (0-6.5%), alteration in body image and sometimes distressing functional consequences for the patients [2] . In the past the use of local excision was limited to highrisk patients for major surgery, especially in the elderly and those who refused radical surgery because of permanent colostomy. However, the high number of complications, functional sequels and sphincter sacrifice rates associated with radical resection prompted researchers to reevaluate local excision for distal rectal cancer as an al- Key Words Rectal cancer ؒ Preoperative staging ؒ Preoperative radiotherapy and chemotherapy ؒ Transanal endoscopic microsurgery Abstract Background: Local excision of rectal cancer is an alternative to radical resection but today its role surrounding the management of patients with early stage rectal cancer (T1-T2-N0) represents an important surgical issue. Aim: To analyze the results of 135 patients with early stage low rectal cancer treated with local excision by transanal endoscopic microsurgery and in the case of T2 also by neoadjuvant therapy. Study Design: 135 patients with T1-T2-N0-M0 rectal cancer were enrolled in the study. Staging according to the definitive histological findings was as follows: pT0 in 24 patients (17.8%), pT1 in 66 patients (48.8%) and pT2 in 45 patients (33.4%). Results: Minor complications were observed in 12 patients (8.8%) whereas major complications were seen only in 2 patients (1.5%). At a median follow-up of 78 (36-125) months, local recurrences occurred in 4 patients and distal metastasis in 2 patients (all patients were staged preoperatively T2). Disease-free survival rates in T1 and T2 patients were 100 and 93% respectively at the end of follow-up. Conclusions: With respect to local recurrence and survival rate, the long-term results of early stage rectal cancer in patients
doi:10.1159/000099173 pmid:17384511 fatcat:ob5bldvq2rflvcwvxtx6x3cscu