This is an early preliminary report for curative local excision of early rectal cancer. Patients with early rectal adenocarcinoma located in the distal rectum were considered for enrollment in this trial. Patients were eligible if their tumor met
the
following critieria: ① lower rectal cancer with histologic confirmation; ② polypoid and mobile shape on digital rectal and sigmoidscopic examination; ③ without evidence of regional lymph node involvement or distal metastasis(clinicl stage
T1T0M0,
T2N0M0); ④ preferable in case of old age with high risk. We gave all available information to the patients about the risks & benefits of local curative therapy and obtained their consent. Since October 1993, we experienced 15 patients(2 males
and
13
females), 39 to 81 years of age, 12 of which had good eligibility criteria for a curative local excision. One patients with multiple liver metastasis underwent palliative transanal complete resection. One patient had a history of previous low
anterior
resection with chemotherapy and radiotherapy. One had evidence of regional lymph node metastasis(clinical stage T3N1M0). All patients underwent transanal resection. 7 patients with T1 and one patients with local recurrence underwent surgical
excision
only. 3 patients were treated with fluorouracil, 2 were treated with chemoimmunoradiation (4500cGy, 5FU and porysaccharide-K) and 1 with chemoradiation. One patient underwent palliative resection, and was then treated with fluorouracil and low
dose
leucovorine. With a short range follow up of 2 years there have been no local recurrence of distant failure with the 12 patients who met the strict criteria. Curative local excision of early low rectal cancer in highly selected cases is a
relatively
safe and acceptable procedure.
|