Skip to main content
SpringerLink
Log in

Is Local Excision of T2/T3 Rectal Cancers Adequate?

  • Conference paper
Rectal Cancer Treatment

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 165))

Abstract

In selected patients, local excision of rectal cancer may be an alternative to radical surgery such as abdominoperineal excision of the rectum or anterior resection. Local excision carries lower mortality and morbidity, without the functional disturbance or alteration in body image that can be associated with radical surgery. There are several techniques of local therapy for rectal cancer, with most experience being available in transanal excision. Transanal endoscopic microsurgery is also used but experience with this newer technique is limited. Patient selection is the most important factor in successful local excision; however, specific criteria for selecting patients have not been universally accepted. Review of the published literature is difficult because of the variation in adjuvant therapy regimes and follow-up strategies, as well as results reported in terms of local recurrence and survival rates. There is increasing evidence to suggest that local excision should be restricted to patients with T1-stage rectal cancer without high-risk factors. The place for local excision in patients with T2 or high-risk T1 tumours requires prospective, randomised multicentre trials comparing radical surgery with local excision, with or without adjuvant therapy. Local excision for T3 tumours should be restricted to the palliative setting or patients unfit for radical surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Ambacher T, Kasperk R, Schumpelick V (1999) Effect of transanal excision on rate of recurrence of stage I rectal carcinomain comparisonwith radical resection methods. Chirurg 70:1469–1474

    Article  PubMed  Google Scholar 

  • Balani A, Turoldo, A, Braini A, Scaramucci M (1999) Role of curative local excision in rectal cancer. Annali Italiani di Chirurgia 70:713–720

    PubMed  Google Scholar 

  • Balani A, Turoldo A, Braini A, Scaramucci M, Roseano M, Leggeri A (2000) Local excision for rectal cancer. J Surg Oncol 74:158–162

    Article  PubMed  Google Scholar 

  • Benson R, Wong CS, Cummings BJ, Brierley J, Catton P, Ringash J, Abdolell M (2001) Local excision and postoperative radiotherapy for distal rectal cancer. Intl J Radiat Oncol Biol Phys 50:1309–1316

    Article  Google Scholar 

  • Blair S, Ellenhorn JD (2000) Transanal excision for low rectal cancers is curative in early-stage disease with favorable histology. Am Surg 66:817–820

    PubMed  Google Scholar 

  • Bleday R, Breen E, Jessup JM, Burgess A, Sentovich SM, Steele G Jr. (1997) Prospective evaluation of local excision for small rectal cancers. Dis Col Rectum 40:388–392

    Google Scholar 

  • Brodsky JT, Richard GK, Cohen AM, Minsky BD (1992) Variables correlated with the risk of lymph node metastasis in early rectal cancer. Cancer 69:322–326

    PubMed  Google Scholar 

  • Buess G, Theiss R, Gunther M, Hutterer F, Pichlmaier H (1985) Endoscopic surgery in the rectum. Endoscopy 17:31–35

    PubMed  Google Scholar 

  • Camilleri-Brennan J, Steele RJ (1998) Quality of life after treatment for rectal cancer. Br J Surg 85:1036–1043

    Article  PubMed  Google Scholar 

  • Chakravarti A, Compton CC, Shellito PC, Wood WC, Landry J, Machuta SR, Kaufman D, Ancukiewicz M, Willett CG (1999) Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg 230:49–54

    Article  PubMed  Google Scholar 

  • Coco C, Magistrelli P, Granone P, Roncolini G, Picciocchi A (1992) Conservative surgery for early cancer of the distal rectum. Dis Col Rectum 35:131–136

    Article  Google Scholar 

  • Fortunato L, Ahmad NR, Yeung RS, Coia LR, Eisenberg BL, Sigurdson ER, Yeh K, Weese JL, Hoffman JP (1995) Long-term follow-up of local excision and radiation therapy for invasive rectal cancer. Dis Col Rectum 38:1193–1199

    Article  Google Scholar 

  • Frazee R, Patel R, Belew M, Roberts J, Hendricks J (1995) Transanal excision of rectal carcinoma. Am Surg 61:714–717

    PubMed  Google Scholar 

  • Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguilar J (2002) Salvage radical surgery after failed local excision for early rectal cancer. Dis Col Rectum 45:875–879

    Article  Google Scholar 

  • Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff RD, Rothenberger DA (2000) Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg 231:345–351

    Article  PubMed  Google Scholar 

  • Goligher J (1984) Surgery of the anus, colon and rectum. Bailliere Tindall, London.

    Google Scholar 

  • Goligher JC, Lee PW, MacFie J, Simkins KC, Lintott DJ (1979) Experience with the Russian model 249 suture gun for anastomosis of the rectum. Surg, Gynecol Obstet 148:516–524

    Google Scholar 

  • Graham RA, Hackford AW, Wazer DE (1999) Local excision of rectal carcinoma: a safe alternative for more advanced tumors? J Surg Oncol 70:235–238

    Article  PubMed  Google Scholar 

  • Gualdi GF, Casciani E, Guadalaxara A, d'Orta C, Polettini E, Pappalardo G (2000) Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging. Dis Col Rectum 43:338–345

    Google Scholar 

  • Hager T, Gall FP, Hermanek P (1983) Local excision of cancer of the rectum. Dis Col Rectum 26:149–151

    Google Scholar 

  • Hainsworth P, Egan M, Cunliffe W (1997) Evaluation of a policy of total mesorectal excision for rectal and rectosigmoid cancers. Br J Surg 84:652–656

    Article  PubMed  Google Scholar 

  • Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? B J Surg 69:613–616

    Google Scholar 

  • Kim CJ, Yeatman TJ, Coppola D, Trotti A, Williams B, Barthel JS, Dinwoodie W, Karl RC, Marcet J (2001) Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg 234:352–358

    Article  PubMed  Google Scholar 

  • Le Voyer TE, Hoffman JP, Cooper H, Ross E, Sigurdson E, Eisenberg B (1999) Local excision and chemoradiation for low rectal T1 and T2 cancers is an effective treatment. Am Surg 65:625–630

    PubMed  Google Scholar 

  • Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J (2000) Is local excision adequate therapy for early rectal cancer? Dis Col Rectum 43:1064–1071

    Google Scholar 

  • Miles W (1908) A method of performing abdominoperineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon. Lancet 2:1812

    Google Scholar 

  • Minsky BD, Rich T, Recht A, Harvey W, Mies C (1989) Selection criteria for local excision with or without adjuvant radiation therapy for rectal cancer. Cancer 63:1421–1429

    PubMed  Google Scholar 

  • Mohiuddin M, Marks G, Bannon J (1994) High-dose preoperative radiation and full thickness local excision: a newoption for selected T3 distal rectal cancers. Intl J Radiat Oncol Biol Phys 30:845–849

    Google Scholar 

  • Mohiuddin M, Regine WF, Marks GJ, Marks JW(1998) High-dose preoperative radiation and the challenge of sphincter-preservation surgery for cancer of the distal 2 cm of the rectum. Intl J Radiat Oncol Biol Phys 40:569–574

    Article  Google Scholar 

  • National Statistics Online (2003) Cancer Trends. National Statisticswebsite: www.statistics.gov.uk

    Google Scholar 

  • Nicholls RJ, Mason AY, Morson BC, Dixon AK, Fry LK (1982) The clinical staging of rectal cancer. Br J Surg 69:404–409

    PubMed  Google Scholar 

  • Ota DM, Skibber J, Rich T (1992) M.D. Anderson Cancer Center experience with local excision and multimodality therapy for rectal cancer. Surg Oncol Clin North Am 1:147–152

    Google Scholar 

  • Otmezguine Y, Grimard L, Calitchi E, Despretz J, Mazeron JJ, Le Bourgeois JP, Pierquin B, Julien M (1989) A new combined approach in the conservative management of rectal cancer. Intl J Radiat Oncol Biol Phys 17:539–545

    Google Scholar 

  • Pricolo V, Potenti F (2001) Modern management of rectal cancer. Dig Surg 18:1–20

    Article  PubMed  Google Scholar 

  • Rothenberger DA, Garcia-Aguilar J (2000) Role of local excision in the treatment of rectal cancer. Seminars Surg Oncol 19:367–375

    Article  Google Scholar 

  • Russell A, Harris J, Rosenberg P et al (2000) Anal sphincter conservation for patients with adenocarcinoma of the distal rectum: long term results of radiation therapy oncology group protocol 89-02. Intl J Radiat Oncol Biol Phys 46:313–322

    Article  Google Scholar 

  • Sengupta S, Tjandra JJ (2001) Local excision of rectal cancer: what is the evidence? Dis Col Rectum 44:1345–1361

    Google Scholar 

  • Sitzler P, Seow-Choen F, Ho Y, Leong A (1997) Lymph node involvement and tumour depth in rectal cancers: an analysis of 805 patients. Dis Col Rectum 40:1472–1476

    Article  Google Scholar 

  • Spencer MP (2001) Transanal excision for T1 and T2 rectal cancer-efficacy of local resection vs. adjuvant therapy. Extended abstract. Swiss Surg 7:275–277

    PubMed  Google Scholar 

  • Steele GD Jr, Herndon JE, Bleday R, Russell A, Benson A III, Hussain M, Burgess A, Tepper JE, Mayer RJ (1999) Sphincter-sparing treatment for distal rectal adenocarcinoma. Ann Surg Oncol 6:433–441

    Article  PubMed  Google Scholar 

  • Taylor RH, Hay JH, Larsson SN (1998) Transanal local excision of selected low rectal cancers. Am J Surg 175:360–363

    Article  PubMed  Google Scholar 

  • Tobaruela E, Arribas D, Mortensen N (1999) Is endosonography useful to select patients for endoscopic treatment of rectal cancer? Revista Espanola de Enfermedades Digestivas 91:614–621

    PubMed  Google Scholar 

  • Valentini V, Morganti AG, De Santis M, Vecchio FM, Coco C, Picciocchi A, Cellini N (1996) Local excision and external beam radiotherapy in early rectal cancer. Intl J Radiat Oncol Biol Phys 35:759–764

    Article  Google Scholar 

  • Varma MG, Rogers SJ, Schrock TR, Welton ML (1999) Local excision of rectal carcinoma. Arch Surg 134:863–867

    Article  PubMed  Google Scholar 

  • Visser BC, Varma MG, Welton ML (2001) Local therapy for rectal cancer. Surg Oncol 10:61–69

    Article  PubMed  Google Scholar 

  • Wagman R, Minsky, BD, Cohen, AM, Saltz, L, Paty, PB, Guillem, JG (1999) Conservative management of rectal cancer with local excision and postoperative adjuvant therapy. Intl J Radiat Oncol Biol Phys 44:841–846

    Article  Google Scholar 

  • Wexner SD, Rotholtz NA (2000) Surgeon influenced variables in resectional rectal cancer surgery. Dis Col Rectum 43:1606–1627

    Google Scholar 

  • Willett CG, Compton CC, Shellito PC, Efird JT (1994) Selection factors for local excision or abdominoperineal resection of early stage rectal cancer. Cancer 73:2716–2720

    PubMed  Google Scholar 

  • Zenni GC, Abraham K, Harford FJ et al (1998) Characteristics of rectal carcinomas that predict the presence of lymph nodemetastases: implications for patient selection for local therapy. J Surg Oncol 67:99–103

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Academic Surgical Unit, Castle Hill Hospital, Cottingham, HU16 5JQ, UK

    J. R. T. Monson

Authors
  1. D. L. Beral
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. R. T. Monson
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Abteilung für Allgemeine, Viszerale, Unfallchirurgie und Poliklinik, Chirurgische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Markus W. Büchler  & Jürgen Weitz  & 

  2. Chirurgie, Krankenhaus Gerresheim, Kliniken der Landeshauptstadt, Gräulinger Straße 120, 40625, Düsseldorf, Germany

    Bernward Ulrich

  3. The Pelican Cancer Foundation, North Hampshire Hospital, Basingstoke, Hampshire, RG24 9NA, UK

    Richard John Heald (OBE, Surgical Director) (OBE, Surgical Director)

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Beral, D.L., Monson, J.R.T. (2005). Is Local Excision of T2/T3 Rectal Cancers Adequate?. In: Büchler, M.W., Weitz, J., Ulrich, B., Heald, R.J. (eds) Rectal Cancer Treatment. Recent Results in Cancer Research, vol 165. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-27449-9_14

Download citation

  • DOI: https://doi.org/10.1007/3-540-27449-9_14

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-23341-1

  • Online ISBN: 978-3-540-27449-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation