Outcomes of Local Excision for Early Rectal Cancer: a 6-year Experience from the Largest University Hospital in Thailand

Background: This study aimed to determine clinical outcomes of local excision for early rectal cancer from aUniversity Hospital in Thailand. Materials and
Methods: We performed a retrospective review of 22 consecutivepatients undergoing local excision for early rectal cancer (clinical and radiological T1/T2) from 2005-2010 at theFaculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. Data were collected from patients’ medicalrecords, including demographic and clinical characteristics, pathological report and surgical outcomes.
Results:This study included 10 males and 12 females, with average age of 68 years. Nineteen patients (86%) underwenttransanal excision and the others had trans-sacral excision. Median operative time was 45 minutes. Postoperativecomplications occurred in 2 patients (9%); 1 fecal fistula and 1 wound infection following trans-sacral excision.There was no 30-day postoperative mortality. Median hospital stay was 5 days. Pathological reports revealedT1 lesion in 12 cases (55%), T2 lesion in 8 cases (36%) and T3 lesion in 2 cases (9%). Eight patients receivedadditional treatment; one re-do transanal excision, two proctectomies, and five adjuvant chemoradiation. Duringthe median follow-up period of 25 months, local recurrence was detected in 4 patients (18%); two cases of T2lesions with close or positive margins, and two cases of T3 lesions. Three patients with local recurrence underwentsalvage abdominoperineal resection. No local recurrence was found in T1/T2 lesions with free surgical margins.
Conclusions: Local excision is a feasible and acceptable alternative to radical resection only in early rectal cancerwith free resection margins and favorable histopathology.