Local Excision of Small Distal Rectal Cancers

Abstract

Radical resections for rectal cancer have been associated with a significant morbidity and mortality. The original Miles resection had a perioperative mortality of 40%.[1] Rosen et al. reported a 61% incidence of postoperative complications following abdominoperineal resections (APRs).[2] Others have reported a 50% urinary complication rate and a high perineal wound infection rate (16%).[3] Disadvantages of the APR also include psychological and quality-of-life issues primarily related to the permanent colostomy. When Williams and Johnston[4] surveyed patients for their satisfaction after receiving an APR, they found that 66% of patients had significant leaks from their stoma appliances, 67% complained of sexual dysfunction, and only 40% of those patients working preoperatively returned to work. There was also a significant change in body image compared with sphincter-saving procedures. Because of the significant problems associated with a radical resection for rectal cancer, local therapies have been used for selected patients over the years to adequately treat the rectal cancer but avoid the morbidity, mortality, and quality-of-life changes. These treatments include local excisions via the transanal, transcoccygeal, or transphincteric route; fulgaration of low-lying tumors with cautery; and intracavitary radiation. Local excision has been the approach most often used and is discussed in detail. The other techniques (fulgaration, intracavitary radiation) are rarely used but do have a very limited role in selected cases.