Local excision of rectal carcinoma: A safe alternative for more advanced tumors?
✍ Scribed by Graham, Roger A.; Hackford, Alan W.; Wazer, David E.
- Publisher
- John Wiley and Sons
- Year
- 1999
- Tongue
- English
- Weight
- 56 KB
- Volume
- 70
- Category
- Article
- ISSN
- 0022-4790
No coin nor oath required. For personal study only.
✦ Synopsis
Background and objectives:
Local excision of rectal carcinoma has primarily been limited to patients with small (< or =3 cm), early rectal carcinoma. we wanted to determine whether local excision (transanal or transacral), when combined with selective chemoradiation therapy, would be adequate treatment for patients with larger (>3 cm) and more advanced t3 and n1 tumors.
Methods:
A prospective study of 20 patients with clinical t1-t3, n0-n1 rectal carcinoma was initiated in 1990. local excision (transanal or transacral) was performed on all patients. sixteen patients were treated with postoperative 5-fluorouracil (5-fu) and leucovorin (lv) combined with radiation therapy; six high-risk patients (t3 or n1) received an additional 6 months of 5-fu and lv. all patients were followed for a minimum of 4 years.
Results:
Tumor size ranged from 2 to 5.5 cm (mean, 3.6 cm). histology revealed well or moderate differentiation (19/20), gross or microscopic ulceration (14/20), and vessel invasion (5/20). mucosal margins were 3-12 mm (mean, 8.3 mm); radial margins were clear in all patients except one (microscopically positive). five patients had t3 tumors; two had node positive tumors (n1). with a median follow-up of 56 months (48-71), there have been no local or regional failures and two patients have died from metastatic disease.
Conclusions:
Local excision, when combined with selective chemoradiation therapy, can be safely applied to patients with large (>3 cm) and more advanced t3 and n1 rectal carcinomas.