Oncological outcomes of transanal local excision for high risk T(1) rectal cancers

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 be tween 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.