Local excision of cancer of the rectum

Abstract

Local excision of rectal cancer can be a part of treatment of this tumor. The authors do not feel that this procedure is only palliative. Clinical staging I and II, tumor diameter less than 3 cm, malignancy grade 1 or 2, invasion no deeper than the submucosa, and no signet-cell carcinoma are all requisites for limited, local excision of rectal carcinoma. Patients operated upon under these criteria have a five-year survival rate of 89.6 +/- 21.7 per cent for those with invasion into the submucosa and 78 +/- 49.9 per cent for those with invasion into the muscularis propria. But to get such good results, strict self control must be exercised in selecting patients.

Characteristics of rectal carcinomas that predict the presence of lymph node metastases: implications for patient selection for local therapy

“…Morson [12], reported that only 12% of tumors with incomplete wall penetration presented with positive lymph nodes. Based on this report and others [13][14][15][16][17], it has been suggested that local excision can safely be performed on tumors that do not exhibit complete wall penetration or are poorly differentiated. Some investigators have included a size restriction.…”

“…Some investigators have included a size restriction. Biggers et al [14] and Hager et al [17], recommended the use of local therapy only for lesions measuring 3 cm or less, while Gingold et al [18], in reviewing the results of local therapy with electrofulguration, broadened this criteria to include tumors up to 4 cm. This recommendation has been generally accepted despite the fact that Greaney and associates found no relationship between tumor size and lymphatic involvement [19].…”

Lokale Therapieprinzipien beim Rektumkarzinom

“…Nur vereinzelte Publikationen berichteten über güns-tige Ergebnisse der LE in der Behandlung des Rektumkarzinoms. Nach LE von T1-Tumoren konnten Fünfjahres-überlebensraten von 82% (Patienten: n=143 [28]), 84% (n=86 [6]) und 90% (n=39 [12]) beobachtet werden, nach LE von T2-Tumoren 78% (n=20 [12]). …”

“…Diese klinischen Erfahrungen, gepaart mit detaillierten histopathologischen Untersuchungen, machten die Notwendigkeit strikter Selektionskriterien für die Indikation zur LE mit kurativer Intention deutlich [12]. Denn erst durch die histopathologische Bestäti-gung wird die in kurativer Absicht durchgeführte lokale Exzision zur adäquaten onkologischen Therapie eines Rektumkarzinoms.…”

Pathogenesis of Local Recurrence after Surgical Treatment of Rectal Carcinoma

“…The investigation is based on 499 patients who complied with the following criteria: (1) carcinoma infiltrating at least the muscularis propria (carcinomas infiltrating only the submucosa, so-called early cancers, were excluded from the study, since none of the 33 patients with such tumors treated by classical radical surgery, demonstrated any signs of local recurrence; (2) only those presenting adenocarcino- (6) surgical treatment comprising low ante rior resection with re-establishment of continuity, or abdominoperi neal excision of the rectum (due to leakage of the anastomosis some days after the first operation, 2 patients with low anterior resection and secondary excision of the rectum were excluded); (7) no prior surgical or radiotherapeutic treatment; (8) en bloc surgery with no rupture of the surgical specimen, and no incision through tumor tis sue; (9) no intraoperative extension of the procedure involving the additional resection of neighboring organs; (10) curative surgery (R classification Rn; (11) no distant métastasés (M0, also no synchro nous curatively removed distart métastases); (12) patients surviving the first 3 months following surgery, and ( 13) tumor status known by Dec. 31 1983 (34 patients were excluded on account of unknown tumor status, which corresponded to 6.4% of the 533 patients who met all the other criteria).…”