DAV≤8cm T1 Rectal Cancer:Surgical Approach And Long Term Outcome

Purpose:There are an increasing number of rectal cancer found nowadays,due to the application of early detecting technology such as fecal OB test,not to mention people care about their health more than ever.The application of total mesorectal excision(TME) has bring the local recurrance rate down to less than 10%.however,abdominal radical surgery using TME method has 20-30%and 2-3% rate of perioperative morbidity and mortality.Local excision could avoid many possbile complications caused by radical operations,also has its own edge.This article compares the perioperative complications,local recurrance rate and oncologic outcome between local excision and radical surgery,and tries to find the risk factors that affect the prognosis of T1 rectal cancer.Method:We retrospectively review the colorectal cancer database in union hospital of Fujian Medical University.There are 82 cases of T1 rectal cancer selected in our study,including 42 cases of local excisions(LE group) and 40 cases of abdominal radical surgeries(low anterior resection or abdominal perineal resection----TME group).We compare the perioperative morbidity and mortality,local recurrance rate and long-term survival rate(5 year overall survival rate and 5 year disease free survival rate).We also analyze the risk factors affecting the oncologic outcome of T1 rectal cancer.Result:No perioperative complications diagnosed the LE group,the complication that carries significant difference between these two groups is pneumonia(15.0%vs0,P=0.009).There is no significant difference in 5 year local recurrance rate(LE group 3.3%与 TME group 0,P=0.361) and long term survival rate between these two groups(5-OS: 94.1%vs87.6%,P=0.128;5-DFS: 91.0%vs87.6%,P=0.357).There is no anal or sexual dysfunction in LE group,while in RR group 4 cases of fecal incontinence and 3 cases of sexual dysfunction have beendiagnosed,which reaches statistical significance.The 5 year overall survival rates and 5 year disease free survival rates for LE alone group,LE+CRT group,LE+RR group are 100%,83.3%,100%(P=0.816)and 94.7%,83.3%,100%(P=0.933) Aging is the risk factor that affects the long term oncologic outcome of T1 rectal cancer.(OR=1.254,95%CI 1.055-1.491,P=0.01).Conclusion:Local excion can achieve the same local control and long term survival rate as radical surgery,if cases are selected carefully.The protection of anal and sexual function is superior in local excision than in radical resection.Adjuvent chemoradiation might not improve the long term outcome of T1 rectal cancer after local excision.Aging is the long term survival risk factor in T1 rectal cancer.