A Retrospective Study On Transanal Local Excision Of Low Rectal Cancer

Surgical operation is the most important means of treatment of rectal tumor, surgical treatment, in recent years one of the most important advances in the treatment of low rectal cancer is the operation of anus-preserving operation. Not all patients with rectal cancer are subject to the transabdominal or abdomen unite with perineal radical resection, in the strict indication and follow the premise of the norms of operation, a part of low rectal cancer may be more suitable for local excision. With the improvement of early diagnosis and preoperative staging of tumors, local excision of rectal cancer is widely used in clinic, its operation contains the anus, anal sphincter path, vaginal, after local excision of sacral path and transanal endoscopic minimally invasive operation. Whatever the choice of what kind of operation, with thorough resection of tumor, to obtain a good quality of life, as far as possible to prolong the survival time for the purpose of. In these patients, transanal local excision of the most widely used. In clinical work, how to choose the operation, how to reduce the operation recurrence, be worth exploring in depth direction.Objective:Discuss the risk factors for recurrence of transanal local excision and corresponding treatment.Methods:Retrospective analyses of the clinical data of34cases of transanal local excision of the patients with low rectal cancer in the Central Hospital of Zhuzhou from January1,2005to January1,2009in our hospital. The depth of invasion of the tumor (T stage), histopathological classification and correlation of tumor size, tumor involving the intestinal circumference ratio data and tumor recurrence were statistically analyzed, and the operation refers to how to sign choice, reduce the local recurrence rate and postoperative relevant remedial measures were discussed.Results:Postoperative pathological diagnosis showed moderately differentiated adenocarcinoma in10cases,24cases of rectal carcinoma. The diameter of the tumors was1.0-3.5(median2.4) cm,2.5-6.0from anal verge edge tumor (median4.1) cm, tumor occupying the circumference ratio of10%-35%(median22%).32patients completed the follow-up of4years, another2cases of pTl patients, the follow-up to second years after surgery lost contact, no tumor recurrence in follow-up period. During4years of follow-up rate was94%.4cases of pTis patients were not present recurrence;20cases of pTl patients (follow-up of up to4years) in2patients (10%) developed local recurrence; another8cases, preoperative evaluation for the T1period, postoperative pathology confirmed T2, diagnostic accordance rate was76.5%, including5cases of recurrence, T2transanal local excision with operation recurrence rate was14.7%,5cases in1cases of remedial after radical operation and occurrence of liver metastasis. Statistical analysis showed that T1stage and T2stage of tumor, tumor diameter≥3cm and diameter<3cm, occupy the intestinal circumference ratio≥30%was statistically significant difference in local recurrence. With vascular nerve invasion, histological III,IV stage T1and stage T2patients, the local recurrence rate after pure chemotherapy is lower than the rate of chemotherapy combined with radiotherapy. There is also a statistical significance of local recurrence.Conclusions:T1stage, tumor diameter<3cm, accounting for intestinal circumference<30%cases underwent transanal local excision of postoperative local recurrence rate is lower than the T2stage, tumor diameter≥3cm, accounting for intestinal circumference≥30%cases. T2stage, tumor diameter<3cm, accounting for intestinal circumference<30%of low rectal cancer is more suitable for transanal local excision. Transanal local excision for rectal cancer after negative margin but vascular nerve invasion, histological Ⅲ, Ⅳ stage T2and stage T2patients, postoperative chemotherapy+radiotherapy were local recurrence rate lower than simple chemotherapy.To improve the accuracy of preoperative assessment of tumor stage, the strict grasp the operation of carrying out the necessary remedial measures syndrome, follow operation specification, are important measures to reduce the local recurrence rate, to reduce postoperative complications, and to prolong the survival time of patients.