Yonsei Med J.  2009 Oct;50(5):704-708. 10.3349/ymj.2009.50.5.704.

Recurrences after Local Excision for Early Rectal Adenocarcinoma

• Huh JW
• Park YA
• Lee KY
• Kim SA
• Sohn SK

• KMID: 1103826
• DOI: http://doi.org/10.3349/ymj.2009.50.5.704

Abstract

PURPOSE
The role of local excision in treating rectal cancer patients continues to be controversial. The aim of this study was to evaluate the long-term oncological results of local excision for early rectal adenocarcinomas and review the outcomes of salvage therapy on rectal cancer patients. MATERIALS AND METHODS: Between March 1992 and September 2005, 35 consecutive patients with early-stage primary rectal adenocarcinomas were treated by local excision with curative intent. The mean tumor distance from the anal verge was 5 cm (range, 1-10 cm). RESULTS: The median follow-up was 66 months (range, 17-161 months). Pathological examination revealed 23 cases of T1 and 12 cases of T2. Recurrence had developed in 10 patients (6 local recurrences, 4 systemic recurrences). Purely extrapelvic recurrence was observed in only two (5.7%) patients. Of the eight recurrent patients with surgical salvage, five survived with no evidence of disease at the time of this analysis. The 5-year local recurrence-free and disease-free survival rates were 79.6% and 67.9%, respectively. CONCLUSION: Local excision alone of early-staged rectal adenocarcinomas, even in the ideal candidate, is followed by a relatively higher local recurrence rate than previously reported and may not be a valid modality. Either the use of adjuvant therapy with local excision, even in patients with T1 lesions or the use of preoperative therapy followed by local excision has good promise.

Keyword

Recurrence; rectal adenocarcinoma; local excision

MeSH Terms

Adenocarcinoma/*pathology/surgery
Adult
Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Neoplasm Recurrence, Local/epidemiology/*pathology/surgery
Rectal Neoplasms/*pathology/surgery
Retrospective Studies
Risk Factors
Salvage Therapy
Time Factors
Treatment Outcome

Figure

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  Fig. 1 Five-year disease free survival rates according to the depth of invasion (T).

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  Fig. 2 Five-year overall survival rates according to the depth of invasion (T).

Reference

1. Weiser MR, Landmann RG, Wong WD, Shia J, Guillem JG, Temple LK, et al. Surgical salvage of recurrent rectal cancer after transanal excision. Dis Colon Rectum. 2005. 48:1169–1175.

2. Chakravarti A, Compton CC, Shellito PC, Wood WC, Landry J, Machuta SR, et al. Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg. 1999. 230:49–54.

3. Landmann RG, Wong WD, Hoepfl J, Shia J, Guillem JG, Temple LK, et al. Limitations of early rectal cancer nodal staging may explain failure after local excision. Dis Colon Rectum. 2007. 50:1520–1525.

4. Endreseth BH, Myrvold HE, Romundstad P, Hestvik UE, Bjerkeset T, Wibe A. Norwegian Rectal Cancer Group. Transanal excision vs. major surgery for T1 rectal cancer. Dis Colon Rectum. 2005. 48:1380–1388.

5. Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguílar J. Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum. 2002. 45:875–879.

6. Huh JW, Jung EJ, Park YA, Lee KY, Sohn SK. Preoperative chemoradiation followed by transanal excision for rectal cancer. J Surg Res. 2008. 148:244–250.

7. Abir F, Alva S, Longo WE. The management of rectal cancer in the elderly. Surg Oncol. 2004. 13:223–234.

8. Bleday R, Breen E, Jessup JM, Burgess A, Sentovich SM, Steele G Jr. Prospective evaluation of local excision for small rectal cancers. Dis Colon Rectum. 1997. 40:388–392.

9. Bailey HR, Huval WV, Max E, Smith KW, Butts DR, Zamora LF. Local excision of carcinoma of the rectum for cure. Surgery. 1992. 111:555–561.

10. Russell AH, Harris J, Rosenberg PJ, Sause WT, Fisher BJ, Hoffman JP, et al. Anal sphincter conservation for patients with adenocarcinoma of the distal rectum: long-term results of radiation therapy oncology group protocol 89-02. Int J Radiat Oncol Biol Phys. 2000. 46:313–322.

11. Masaki T, Ono M, Muto T. Outcome of local excision for locally invasive rectal carcinomas with special reference to histological features at the invasive margin. Jpn J Clin Oncol. 1998. 28:621–625.

12. Taylor RH, Hay JH, Larsson SN. Transanal local excision of selected low rectal cancers. Am J Surg. 1998. 175:360–363.

13. Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff RD, Rothenberger DA. Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg. 2000. 231:345–351.

14. Madbouly KM, Remzi FH, Erkek BA, Senagore AJ, Baeslach CM, Khandwala F, et al. Recurrence after transanal excision of T1 rectal cancer: should we be concerned? Dis Colon Rectum. 2005. 48:711–719.

15. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, García-Aguilar J. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum. 2000. 43:1064–1071.

16. Paty PB, Nash GM, Baron P, Zakowski M, Minsky BD, Blumberg D, et al. Long-term results of local excision for rectal cancer. Ann Surg. 2002. 236:522–529.

17. Coco C, Magistrelli P, Granone P, Roncolini G, Picciocchi A. Conservative surgery for early cancer of the distal rectum. Dis Colon Rectum. 1992. 35:131–136.

18. Kirke R, Rajesh A, Verma R, Bankart MJ. Rectal cancer: incidence of pulmonary metastases on thoracic CT and correlation with T staging. J Comput Assist Tomogr. 2007. 31:569–571.

19. Griffiths EA, Browell DA, Cunliffe WJ. Evaluation of a preoperative staging protocol in the management of colorectal carcinoma. Colorectal Dis. 2005. 7:35–42.

20. Penna C, Nordlinger B. Colorectal metastasis (liver and lung). Surg Clin North Am. 2002. 82:1075–1090.

21. Maeda K, Maruta M, Sato H, Hanai T, Masumori K, Matumoto M, et al. Outcomes of novel transanal operation for selected tumors in the rectum. J Am Coll Surg. 2004. 199:353–360.

22. Park KJ, Choi HJ, Roh YH, Shin JS, Lee HS. Local control of local excision for T1/T2 rectal cancer. J Korean Soc Coloproctol. 2007. 23:87–92.

23. Bretagnol F, Rullier E, George B, Warren BF, Mortensen NJ. Local therapy for rectal cancer: still controversial? Dis Colon Rectum. 2007. 50:523–533.