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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2013 October;26(5):337-40
Functional and oncological outcomes after transanal local excision for rectal cancer. A prospective study
Luglio G., Tarquini R., Sivero L., Giglio M. C., De Werra C., Formisano C., D’antonio D., Benassai G., Bucci L.
Department of General, Geriatric Oncologic and Advanced Technologies Federico II University of Naples, Naples, Italy
Aim: Surgery for rectal cancer is impaired by a significant risk of perioperative morbidity, urinary and sexual dysfunction due to nerve injuries and, obviously, the possibility of a temporary or even a permanent stoma. In order to mitigate the sequelae of such a major surgery, trans-anal local excision has been proposed in selected cases to treat rectal cancer. Aim of this prospective study is to investigate which patients might get a benefit from this less invasive treatment, evaluating both oncological and functional results.
Methods: A prospective database has been maintained in our Surgical Coloproctology Unit, registering all cases of rectal cancers that have been treated from 2000 to date. 26 patients from 2000 to 2005 have been treated with local excision; mean age was 76. Each patient has been followed-up for 5 years. All patients were preoperatively staged with endorectal ultrasound; elderly patients, unfit for surgery or refusing major surgery or the possibility of a stoma, with a superficial T1 tumor were mostly considered eligible for local excision. 5-year local and systemic recurrence rate, overall survival and functional outcomes have been assessed.
Results: Sixteen patients were staged as T1 rectal cancer with superficial invasion of the submucosa at the endorectal ultrasound. Two patients had a T2 cancer and refused major surgery or other preoperative treatments. Two patients had a T1 tumors which appeared to deeply infiltrate the submucosa; six patients had a T2 tumors and refused surgery or were considered unfit for it: all of them were offered to have a preoperative radiotherapy plus a local excision. None of the 16 T1 patients had a 5-year local recurrence, despite one of them had a systemic recurrence. Both patients with a T2 tumor and not pretreated with radiotherapy had a local recurrence. One of the T1 and one of the T2 patients pretreated with radiotherapy had a systemic but not local recurrence. Only one patient who was radiated experienced a worsening of a preexisting fecal incontinence.
Conclusion: Transanal local excision of rectal cancers should be offered only in highly selected, low risk, T1 tumors. People with higher risk cancers, unfit or refusing surgery, should at least be treated with preoperative radiotherapy plus local excision.