Premium
Local excision of rectal carcinoma: A safe alternative for more advanced tumors?
Author(s) -
Graham Roger A.,
Hackford Alan W.,
Wazer David E.
Publication year - 1999
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/(sici)1096-9098(199904)70:4<235::aid-jso7>3.0.co;2-0
Subject(s) - medicine , radiation therapy , carcinoma , surgery , rectum , histology , rectal carcinoma , chemotherapy , wide local excision , colorectal cancer , cancer
Background and Objectives Local excision of rectal carcinoma has primarily been limited to patients with small (≤3 cm), early rectal carcinoma. We wanted to determine whether local excision (transanal or transacral), when combined with selective chemoradiation therapy, would be adequate treatment for patients with larger (>3 cm) and more advanced T3 and N1 tumors. Methods A prospective study of 20 patients with clinical T1–T3, N0–N1 rectal carcinoma was initiated in 1990. Local excision (transanal or transacral) was performed on all patients. Sixteen patients were treated with postoperative 5‐fluorouracil (5‐FU) and leucovorin (LV) combined with radiation therapy; six high‐risk patients (T3 or N1) received an additional 6 months of 5‐FU and LV. All patients were followed for a minimum of 4 years. Results Tumor size ranged from 2 to 5.5 cm (mean, 3.6 cm). Histology revealed well or moderate differentiation (19/20), gross or microscopic ulceration (14/20), and vessel invasion (5/20). Mucosal margins were 3–12 mm (mean, 8.3 mm); radial margins were clear in all patients except one (microscopically positive). Five patients had T3 tumors; two had node positive tumors (N1). With a median follow‐up of 56 months (48–71), there have been no local or regional failures and two patients have died from metastatic disease. Conclusions Local excision, when combined with selective chemoradiation therapy, can be safely applied to patients with large (>3 cm) and more advanced T3 and N1 rectal carcinomas. J. Surg. Oncol. 1999;70:235–238. © 1999 Wiley‐Liss, Inc.