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The indication and surgical results of local excision following radiotherapy for low rectal cancer
Author(s) -
Han S.L.,
Zeng Q.Q.,
Shen X.,
Zheng X.F.,
Guo S.C.,
Yan J.Y.
Publication year - 2010
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2009.02078.x
Subject(s) - medicine , radiation therapy , colorectal cancer , surgery , wide local excision , distant metastasis , adjuvant radiotherapy , adenocarcinoma , cancer , metastasis
Aim Radical surgery of rectal cancer is associated with significant morbidity, and some patients with low‐lying lesions must accept a permanent colostomy. The objective of this study was to evaluate the outcome of local excision followed by adjuvant radiotherapy for rectal cancer for curative purposes. Method One hundred and seven patients with rectal carcinoma performed with local excision were analysed retrospectively. Results The procedures of local excision were trans‐anal resection in 83 patients, trans‐sacral resection in 16, trans‐sphincteric local resection in five, and trans‐vaginal resection in three. The overall disease‐free survival rate was 80.4% (86/107), including 90.0% (54/60) for T1 and 72.3% (34/47) for T2 tumours, respectively. Eighty‐two of 107 patients underwent adjuvant postoperative radiotherapy after local excision, and 25 did not, and the DFS rates between radiation and nonradiation group were significantly different for T2 [81.6% (31/38) vs 33.3% (3/9), P < 0.05], but not for T1 tumours (90.9% vs 87.5%, P > 0.05). The rates of local recurrence and distant metastasis were 13.1% (14/107) and 4.7% (5/106), respectively, and the median time to relapse was 15 months (range: 10–53) for local recurrence and 30 months (21–65) for distant recurrence. The risk factors for local recurrence were large tumour (≥3 cm), poorly differentiated adenocarcinoma and T2 tumour. Conclusions Local excision followed adjuvant radiotherapy is an alternative and feasible technique for small T1 rectal cancer in selected cases.