Brief Article
Copyright ©2012 Baishideng. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2012; 4(4): 84-88
Published online Apr 15, 2012. doi: 10.4251/wjgo.v4.i4.84
Oncological outcomes of transanal local excision for high risk T1 rectal cancers
Ze-Yu Wu, Gang Zhao, Zhe Chen, Jia-Lin Du, Jin Wan, Feng Lin, Lin Peng
Ze-Yu Wu, Gang Zhao, Zhe Chen, Jia-Lin Du, Jin Wan, Feng Lin, Lin Peng, Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
Author contributions: Wu ZY and Peng L designed and coordinated the study; all authors did the patient accrual and collected the clinical data; Wu ZY and Zhao G collected and analyzed the data; Chen Z prepared the manuscript; Du JL, Wan J and Lin F revised critically for important intellectual content; all authors read and approved the final manuscript.
Supported by The Guangdong WST Foundation of China, No. 2000112736580706003
Correspondence to: Peng Lin, MD, PhD, Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China. pengl@21cn.com
Telephone: +86-20-83827812-60821 Fax: +86-20-83827812
Received: December 11, 2011
Revised: March 4, 2012
Accepted: March 10, 2012
Published online: April 15, 2012
Abstract

AIM: To evaluate the oncological outcomes of transanal local excision and the need for immediate conventional reoperation in the treatment of patients with high risk T1 rectal cancers.

METHODS: Twenty five high risk T1 rectal cancers treated by transanal local excision at the Guangdong General Hospital were analyzed retrospectively. Twelve patients received transanal local excision and 13 patients underwent subsequent immediate surgical rescue after transanal local excision within 4 wk. Differences in the local recurrence rates and 5-year overall survival rates between the two groups were analyzed. The prognostic value of immediate conventional reoperation for high risk T1 rectal cancers was also evaluated.

RESULTS: The median follow-up period was 62 mo. The local recurrence rates after transanal local excision for high risk T1 rectal cancer were 50%. By immediate conventional reoperation, the local recurrence rates were significantly reduced to 7.7%. The difference between these two groups was statistically significant (P = 0.030). Kaplan-Meier survival analysis showed a trend for decreased 5-year overall survival rates for patients treated by transanal local excision compared with immediate conventional reoperation (63% vs 89%).

CONCLUSION: Transanal local excision cannot be considered sufficient treatment for patients with high risk T1 rectal cancers. Immediate conventional reoperation should be performed if the pathology of the local excision is high risk.

Keywords: Rectal cancer; Transanal local excision; Immediate reoperation; Local recurrence; Overall survival