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OUTCOME OF TRANS‐ANAL EXCISION FOR RECTAL CANCER
Author(s) -
Banerjee S.,
Levitt M. D.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04119_13.x
Subject(s) - medicine , surgery , colorectal cancer , histopathology , radiation therapy , malignancy , total mesorectal excision , pathological , anal cancer , wide local excision , adverse effect , radical surgery , gist , cancer , stromal cell , pathology
Aims The aim of this study is to assess the outcome of trans‐anal excision of rectal cancer in a single Surgeon’s practice and determine possible selection criteria for this procedure. Methods Retrospective review of hospital records, specimen histopathology and imaging of consecutive patients with rectal cancer undergoing trans‐anal excision as the primary treatment. Results 25 patients had trans‐anal excision of rectal cancer including 3 cases of carcinoid tumour and 1 case of gastro‐intestinal stromal tumour (GIST). 5/25 proceeded to radical rectal resection because of the presence of adverse features including lympho‐vascular and peri‐neural invasion and poorly differentiated cell type; residual tumour was present in 4/5 cases, nodal metastases in 3/5 patients each of whom received pre‐operative chemotherapy and radiotherapy. 2/25 patients developed recurrence at 12 and 48 months from excision. One of these patients had distant recurrence at 12 months having proceeded to radical rectal resection and the other patient (aged 99), managed with trans‐anal excision alone, recurred locally at 48 months. Both cases of recurrence were T3 tumours. Overall, 19/20 cases managed with trans‐anal excision alone had no recurrence with a follow‐up period of 12–48 months. 16 of these patients had T1 malignancy. Conclusion T1 tumours may be treated with trans‐excision alone in the absence of adverse pathological features. It is unclear from our study whether T2 should be managed in this way due to their small number in this study and T3 tumours are clearly at high risk of recurrence with this treatment alone.