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Outcomes of Local Excision for Early Rectal Cancer: a 6-year Experience from the Largest University Hospital in Thailand

  • Lohsiriwat, Varut (Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Anubhonganant, Worabhong (Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Prapasrivorakul, Siriluck (Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Iramaneerat, Cherdsak (Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Riansuwan, Woramin (Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Boonnuch, Wiroon (Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Lohsiriwat, Darin (Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University)
  • Published : 2013.09.30

Abstract

Background: This study aimed to determine clinical outcomes of local excision for early rectal cancer from a University Hospital in Thailand. Materials and Methods: We performed a retrospective review of 22 consecutive patients undergoing local excision for early rectal cancer (clinical and radiological T1/T2) from 2005-2010 at the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. Data were collected from patients' medical records, including demographic and clinical characteristics, pathological report and surgical outcomes. Results: This study included 10 males and 12 females, with average age of 68 years. Nineteen patients (86%) underwent transanal excision and the others had trans-sacral excision. Median operative time was 45 minutes. Postoperative complications occurred in 2 patients (9%); 1 fecal fistula and 1 wound infection following trans-sacral excision. There was no 30-day postoperative mortality. Median hospital stay was 5 days. Pathological reports revealed T1 lesion in 12 cases (55%), T2 lesion in 8 cases (36%) and T3 lesion in 2 cases (9%). Eight patients received additional treatment; one re-do transanal excision, two proctectomies, and five adjuvant chemoradiation. During the median follow-up period of 25 months, local recurrence was detected in 4 patients (18%); two cases of T2 lesions with close or positive margins, and two cases of T3 lesions. Three patients with local recurrence underwent salvage abdominoperineal resection. No local recurrence was found in T1/T2 lesions with free surgical margins. Conclusions: Local excision is a feasible and acceptable alternative to radical resection only in early rectal cancer with free resection margins and favorable histopathology.

Keywords

Rectal cancer;local excision;recurrence;outcomes;Thailand

References

  1. Albert MR, Atallah SB, de Beche-Adams TC, Izfar S, Larach SW (2013). Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum, 56, 301-7. https://doi.org/10.1097/DCR.0b013e31827ca313
  2. Bentrem DJ, Okabe S, Wong WD, et al (2005). T1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg, 242, 472-7.
  3. Carrara A, Mangiola D, Pertile R, et al (2012). Analysis of risk factors for lymph nodal involvement in early stages of rectal cancer: when can local excision be considered an appropriate treatment? Systematic review and meta-analysis of the literature. Int J Surg Oncol, 2012, 438450.
  4. Chang AJ, Nahas CS, Araujo SE, et al (2008). Early rectal cancer: local excision or radical surgery? J Surg Educ, 65, 67-72. https://doi.org/10.1016/j.jsurg.2007.11.002
  5. Heintz A, Morschel M, Junginger T (1998). Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc, 12, 1145-8. https://doi.org/10.1007/s004649900802
  6. Christoforidis D, Cho HM, Dixon MR, et al (2009). Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg, 249, 776-82. https://doi.org/10.1097/SLA.0b013e3181a3e54b
  7. Friel CM, Cromwell JW, Marra C, et al (2002). Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum, 45, 875-9. https://doi.org/10.1007/s10350-004-6320-z
  8. Han Y, He YG, Lin MB, et al (2012). Local resection for rectal tumors: comparative study of transanal endoscopic microsurgery vs. conventional transanal excision - the experience in China. Hepatogastroenterol, 59, 2490-3.
  9. Jeong WK, Park JW, Choi HS, Chang HJ, Jeong SY (2009). Transanal endoscopic microsurgery for rectal tumors: experience at Korea's national cancer center. Surg Endosc, 23, 2575-9. https://doi.org/10.1007/s00464-009-0466-7
  10. Lohsiriwat V, Lohsiriwat D, Boonnuch W, et al (2008). Outcomes of sphincter-saving operation for rectal cancer without protective stoma and pelvic drain, and risk factors for anastomotic leakage. Dig Surg, 25, 191-7. https://doi.org/10.1159/000140688
  11. Lohsiriwat V, Lohsiriwat D, Thavichaigarn P (2009). Current practices in rectal cancer surgery: a survey of Thai colorectal surgeons. J Med Assoc Thai, 92, 1009-15.
  12. Monson JR, Weiser MR, Buie WD, et al (2013). Practice parameters for the management of rectal cancer. Dis Colon Rectum, 56, 535-50. https://doi.org/10.1097/DCR.0b013e31828cb66c
  13. Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR (2002). Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum, 45, 200-6. https://doi.org/10.1007/s10350-004-6147-7
  14. Schmoll HJ, Van Cutsem E, Stein A, et al (2012). ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. Ann Oncol, 23, 2479-516. https://doi.org/10.1093/annonc/mds236
  15. Paty PB, Nash GM, Baron P, et al (2002). Long-term results of local excision for rectal cancer. Ann Surg, 236, 522-29. https://doi.org/10.1097/00000658-200210000-00015
  16. Peng J, Chen W, Venook AP, et al (2011). Long-term outcome of early-stage rectal cancer undergoing standard resection and local excision. Clin Colorectal Cancer, 10, 37-41. https://doi.org/10.3816/CCC.2011.n.005
  17. Qiu HZ, Lin GL, Xiao Y, Wu B (2008). The use of posterior transsphincteric approach in surgery of the rectum: a Chinese 16-year experience. World J Surg, 32, 1776-82. https://doi.org/10.1007/s00268-008-9630-9
  18. Stipa F, Giaccaglia V, Burza A (2012). Management and outcome of local recurrence following transanal endoscopic microsurgery for rectal cancer. Dis Colon Rectum, 55, 262-9. https://doi.org/10.1097/DCR.0b013e318241ef22
  19. You YN, Baxter NN, Stewart A, Nelson H (2007). Is the increasing rate of local excision for stage I rectal cancer in the United States justified?: a nationwide cohort study from the National Cancer Database. Ann Surg, 245, 726-33. https://doi.org/10.1097/01.sla.0000252590.95116.4f

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