Local excision of low rectal cancer: 12-year follow-up

Abstract

The last decades have seen an increase in rectal cancer, which mainly affects individuals aged over 40 years [1]. The technique of local excision in the treatment of cancer in the middle and lower third of the rectum is gaining momentum, as opposed to low coloanal anastomosis or abdominoperineal (AP) resection. We report a series of 12 consecutive patients (7 male and 5 female, aged 37 to 65 years) who underwent a local excision of T1 to T3 low rectal cancer during the period 2000–2012 after careful selection according to strict criteria. Abdominoperineal resection was suggested in most cases, but patients strongly refused a permanent stoma. All patients were placed in the Jack-Knife position. A close follow-up was maintained for a period of 10 to 144 months. No major complications were recorded during surgery. The postoperative course for eight patients (72%) was uneventful. One patient died after 48 hours due to sepsis, another patient suffering from myelodysplastic syndrome revealed serious bleeding the 5th postoperative day, an obese (140kgr) female patient developed a rectovaginal fistula that required temporary sigmoidostomy, and one patient under medication for myasthenia Gravis developed moderate faecal incontinence. Eleven patients are currently alive and free of disease for a mean period of 68 months. Pathology reports revealed malignancy (T1–T3) in 11 patients. Three (3) patients received neo-adjuvant therapy preoperative chemoradiation therapy, and another patient received postoperative radiation therapy. Local excision of low rectal cancer in accordance with strict criteria, is a safe technique if skillfully performed. Further investigations and trials should be performed to confirm the safety and advantages of this approach.