Conservative treatment for low rectal carcinoma by local excision with or without radiotherapy

Abstract

Thirty-seven patients with low rectal carcinoma were treated by transanal resection between January 1979 and December 1988. Adjuvant radiotherapy was used in eight patients before operation, in 13 after operation and six patients had both preoperative and postoperative radiotherapy. The selection criteria for transanal resection were low, superficial tumours treated conservatively with curative intent (group 1, 18 patients) or patients medically unfit for (12) or refusing (seven) abdominoperineal resection (APR) (group 2, 19 patients). In group 1, the local recurrence rate was 11 per cent with an overall 5-year survival rate of 100 per cent. In group 2, the local recurrence rate was 53 per cent with an overall 5-year survival rate of 35 per cent. There was no postoperative mortality and minimal morbidity. Salvage of local failure was by APR in six patients. The survival rate after local recurrence was 70 per cent at 1 year and 30 per cent at 5 years. Transanal resection can be proposed as a curative procedure for selected low, small, minimally infiltrating and well differentiated adenocarcinomas. Local control might be improved by postoperative radiotherapy for Astler-Coller stage B1 tumours or those above 3 cm in diameter. Further trials should examine the results of high-dose (60 Gy) preoperative radiotherapy so that transanal resection might be employed for favourable post-irradiation stage (0 or A) lesions. This new strategy will benefit from a better evaluation of tumour response after primary radiotherapy and an improved assessment of histological excision margins.

Salvage Radical Surgery After Failed Local Excision for Early Rectal Cancer

“…Cuthbertson et al 6 5 50 100 NS Killingback 9 5 n s 2 0 N S Bailey et al 10 2 3 7 5 0 0 Rouanet et al 7 7 38 71 14% Lock et al 11 9 6 0 5 5 N S Baron et al 12 21 ns 55 NS Romano et al 13 2 29 100 0 Bleday et al 14 3 n s 3 3 0 Steele et al 5 …”

“…[3][4][5] Local recurrence after failed local excision of rectal cancer is often considered amenable to salvage radical surgery. 6 Although some authors have reported high survival rates after salvage surgery, 6,7 the long-term results remain unknown.…”

Phase II Study on Breast Conservative Surgery Plus Chemo- and Radiotherapy in Treating Chinese Patients with Early Staged Breast Cancer

“…Radiotherapy is reported to significantly decrease local recurrence after breast-conserving therapy (Gage et al, 1995). The recurrence rate will be above 60% without, while the rate will decrease to about 9% with postoperative radiotherapy (Rouanet et al, 1993). Thus, in China adjuvant RT is currently recommended for all patients after breast-conserving lumpectomy, regardless of the size of the primary disease, age of patient, and hormonal receptor.…”

Surgical Treatment of Rectal Cancer: Local Resection

“…However, in many patients, the recurrence is locally advanced and some also have distant metastasis. Therefore, not every patient for whom local excision fails, can be cured by radical surgery (Table 3) [60,67,[73][74][75][76][77]. In the University of Minnesota series, a curative radical resection was possible in 79% of patients, but only 59% remained free of disease after a median of 39 months of follow-up.…”