Long Term Outcome of Local Excision for T1-2 Rectal Cancer

Abstract

Purpose. Local excision is an alternative method of treatment for middle to low rectal cancer due to low morbidity and good functional result. We reviewed the experience with local excision of early rectal cancer to evaluate the long term result. Patients & Methods. Between January 1982 and December 2004, patients with T1-2 adenocarcinoma of the middle to lower rectum (below 10 cm from anal verge) treated by local excision were reviewed. The pathology of specimen was reviewed. Seventy-six patients were assessed and 44 were T1 and 32 were T2 cancers. Eleven patients received adjuvant radiation therapy. Data analysis included clinical characteristics and pathological features. The tumor recurrence was identified as local, distant or both. 59 patients (77%) were followed until death or more than five years and 51 patients (67%) were followed until death or more than ten years. The outcomes were defined as five-year and ten-year cumulative data of tumor recurrence rate, cancer-specific and disease-free survival rates. Results. The ten-year local and overall recurrence rate were 9.1% and 15.9% for T1 lesion and 12.5% and 21.9% for T2 lesion. The five-year and ten-year cancer-specific survival rates of T1 lesion were 97.2% and 92.1% and of T2 lesion were 83.9% and 76.3%. On multivariate analysis, the significant prognostic factors of cancer-specific survival rate were T stage (p=0.038) and angio-vascular invasion (p＜0.001). The only significant factor of disease-free survival rate was angio-vascular invasion (p＜0.001). Of the eight patients who had isolated local recurrence, five patients received salvage surgery and the disease-free survival rate was 60% with mean follow up of 77 months. Conclusion. Local excision for middle to lower T1 rectal cancer is acceptable with good long-term result but is not considered in T2 lesion due to unsatisfied cancer-specific survival rate. The pathological feature of angio-vascular invasion seems to be the prognostic factor of diseasefree and cancer-specific survival.