The Value Of Transanal Local Excision For Lower Rectal Cancer

Object:To investigate the value of transanal local excision for lower rectal cancer.Methods: The clinical data of77patients who suffered lower rectal cancer werecollected in The first Affiliated Hospital of Dalian Medical Universty from March2002to March2008. All cases were clinical stage T1to T2with high-middle differentiationand without lymph node metastase,who received digital rectal examination, colonscopy,CT, MRI and some of them received endorectal ultrasonography before operation.There were35patients underwent transanal local excision(group A),while42patientsunderwent traditional radical operation(group B).The following parameters wereevaluated:operating time,blood loss,hospital stay and complication,as well as recurrencerate and survival.Results: The group B showed a statistically significant longer operation time,moreblood loss and longer duration of postoperative hospital stay when compared to thegroup A(T-test,P＜0.05). The incidence of complication was2.9%(1/35)in groupA,while the incidence of complication was14.3%(6/42)in group B.The incidence ofcomplication was significant higher compared to group A. The5-year survival rate ofgroup A was97.1%and the5-year survival rate of group B was97.6%．There was nosignificantly statistical difference on the5-year survival rate between the twogroups(P>0.05)．For the pT1patients,the5-year survival rate was100%in group Aand group B.And for the T2patinets, the5-year survival rate was85.7%in group A and91.7%(11/12)in group B,but the difference was not statistically significant.Therecurrence rate in group A was11.4%and that was2.4%in group B. There was nosignificantly statistical difference on the recurrence rates between the twogroups(P>0.05). For the T1patients,the recurrence rates was7.1%in group A and therewas no recurrent case in group B.And for the T2patinets, the recurrence rates was28.6%in group A and8.3%in group B,and the difference was not statisticallysignificant.However, the recurrence rate for the T2patients in group A was significant higher compared to the T1patients in the group A.Conclusion:Transanal local excision for lower rectal cancers with stage pT1topT2can gain similar prognosis with shorter operation time,less blood loss and fewercomplication compared to traditional radical operation. But for pT2patients,localexcision was not enough because of high recurrence rate.Rigid indication and standardoperation can reduce the recurrence rate.