Long term results of local excision alone in patients with early rectal cancer.

Konference: 2007 XXXI. Brněnské onkologické dny a XXI. Konference pro sestry a laboranty

Kategorie: Kolorektální karcinom

Téma: XVI. Kolorektální karcinom

Číslo abstraktu: 146

Autoři: Prof. M.D. Massimo Federico

Forty nine patients underwent local excison for rectal cancer in the last 18 years and were followed for a mean time of 90.9
months (range: 3 -240) after surgery.
Preoperative selection included CT-scan / MRI of the pelvis and rectal endosonography in attempt to select early rectal cancer (T1/T2 and N0 tumors) with a diameter smaller than 3 cm.
Full-disc excision was performed through the transanal or the transphincteric (after Mason) approach. The latter was abbounded in year 2000.
The definitive hystological examination of the specimen determined or not the adequacy of the limited treatment: tumors infiltrating the whole muscolar layer and/or with high risk-hystology (poor differentiation, lymphatic or vascular invasion) were considered not adequately treated and the patients were invited to undergo an abdominoperineal resection (salvage surgery).
In the group of 33 patiens in whom the cancer was confined to the submucosa (pT1) the recurrence rate was 6%. In 8 cases with invasion of the internal muscolar layer (pT2a) and low-risk histology, local recurrence occurred in 25%.
Finally in the group of patients with tumor invading the outer muscolar layer (pT2b) or with high-risk histolgy in whom salvage surgery was not performed because poor general condition or refusal, the recurrence rate was 50%.
The mean disease-free interval in the recurred patients was 27 months ranging from 11 to 48 months.

On the basis of our experience and according with the data of the literature we strongly suggest to perform local excision alone only for tumors limited to the submucosa with low-risk histology.
Counseling of the patient and accurate preoperative study are fundamental to achieve good results.

Datum přednesení příspěvku: 24. 4. 2007