Long-Term Results of Local Excision for Rectal Cancer

Abstract

Ten-year local recurrence and survival rates were 17% and 74% for T1 rectal cancers and 26% and 72% for T2 cancers. Median time to relapse was 1.4 years (range 0.4-7.0) for local recurrence and 2.5 years (0.8-7.5) for distant recurrence. In patients receiving radiotherapy, local recurrence was delayed (median 2.1 years vs. 1.1 years), but overall rates of local and overall recurrence and survival rates were similar to patients not receiving radiotherapy. Among 26 cancer deaths, 8 (28%) occurred more than 5 years after local excision. On multivariate analysis, no clinical or pathologic features were predictive of local recurrence. Intratumoral vascular invasion was the only significant predictor of survival. Among 34 patients who developed tumor recurrence, the pattern of first clinical recurrence was predominantly local: 50% local only, 18% local and distant, and 32% distant only. Among the 17 patients with isolated local recurrence, 14 underwent salvage resection. Actuarial survival among these surgically salvaged patients was 30% at 6 years after salvage. CONCLUSIONS The long-term risk of recurrence after local excision of T1 and T2 rectal cancers is substantial. Two thirds of patients with tumor recurrence have local failure, implicating inadequate resection in treatment failure. In this study, neither adjuvant radiotherapy nor salvage surgery was reliable in preventing or controlling local recurrence. The postoperative interval to cancer death is as long as 10 years, raising concern that cancer mortality may be higher than is generally appreciated. Additional treatment strategies are needed to improve the outcome of local excision.

Transanal Endoscopic Microsurgery (TEM) for Rectal Cancer: University Hospital of North Tees Experience

“…However, historical data on transanal excisions showed unacceptably high local recurrence rates (LR) (0-28.8 %) [11][12][13][14][15].…”

Safe Transanal Tumor Resection Using a Harmonic Scalpel

“…25 However, according to Paty et al, the local recurrence rate and diseasespecific survival rate at 10 years of follow-up are 17 and 74%, respectively, for SM cancer cases, and 26 and 72%, respectively, for MP cancer cases. 26 Appropriate informed consent and due caution are necessary for implementing local resection of SM massive or deeper cancers.…”

Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms

“…This is expected, since the risk of lymph node involvement for T2 and T3 rectal adenocarcinomas is high (12%-28% and 36%-79%, respectively 22,32,35 ). Concerning T2 lesions, Lee, et al 21 compared patients with T1N0M0 and T2N0M0 rectal adenocarcinomas treated by TEM alone (74 patients) or by radical surgery (100 patients).…”

“…However, patients have to experience long operative time and are exposed to postoperative complications such as bleeding, suture dehiscence, temporary or definitive colostomy, sexual or urinary dysfunctions, pneumonia and thromboembolic events. In this context, TEM appeared as an attractive alternative, however precise preoperative staging is imperative since the procedure does not remove all perirectal lymph nodes (the risk of its involvement is 0%-12% for T1 cancers, 12%-28% for T2 cancers, 36%-79% for T3 cancers 25,32,35 ). Therefore, local recurrence is a major concern and careful patient selection is mandatory to optimize results.…”