Local Treatment for Rectal Cancer

ABSTRACT

The treatment of rectal cancer includes both radical resection and local therapy. Radical resection remains the standard treatment, but is associated with increased morbidity and mortality, as well as the potential need for a temporary and occasionally, a permanent ostomy. The benefits of local treatment include a less invasive procedure with maintenance of bowel function and avoidance of a stoma. However, the efficacy of local treatment is now being challenged as the rates of recurrence after local excision alone appear to be much higher than previously thought. Although the primary goal of an oncologic resection is disease eradication, each case must be individualized to determine an optimal care plan.

Rectal cancer - local excision - recurrence - transanal endoscopic microsurgery - radiation therapy - chemotherapy

REFERENCES

• 1 Lisfranc J. Observation sur une affection cancereuse du rectume guerie par l'excision.  Rev Med Franc Etrang. 1826;  2 380-382
• 2 Czerny V. Casuistische mittheilugen aus der chirurg Klin zu Heidelberg.  Munch Med Wchnschr. 1894;  11-14
• 3 Miles W E. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon.  Lancet. 1908;  ii 1812-1813
• 4 Lavery I C, Lopez-Kostner F, Fazio V W et al.. Chances of cure are not compromised with sphincter-saving procedures for cancers of the lower third of the rectum.  Surgery. 1997;  122(4) 779-784
• 5 Zaheer S, Pemberton J H, Farouk R et al.. Surgical treatment of adenocarcinoma of the rectum.  Ann Surg. 1998;  227(6) 800-811
• 6 Mohiuddin M, Regine W F, Marks G J, Marks J W. High-dose preoperative radiation and the challenge of sphincter-preservation surgery for cancer of the distal 2 cm of the rectum.  Int J Radiat Oncol Biol Phys. 1998;  40(3) 569-574
• 7 Fazio V W. Cancer of the rectum - sphincter-saving operation. Stapling techniques.  Surg Clin North Am. 1988;  68(6) 1367-1382
• 8 Balch G C, DeMeo A, Guillem J G. Modern management of rectal cancer: a 2006 update.  World J Gastroenterol. 2006;  12(20) 3186-3195
• 9 Stipa F, Chessin D B, Shia J et al.. A pathologic complete response of rectal cancer to preoperative combined-modality therapy results in improved oncological outcome compared with those who achieve no downstaging on the basis of preoperative endorectal ultrasonography.  Ann Surg Oncol. 2006;  13(8) 1047-1053
• 10 Kim D W, Lim S B, Kim D Y et al.. Pre-operative chemo-radiotherapy improves the sphincter preservation rate in patients with rectal cancer located within 3 cm of the anal verge.  Eur J Surg Oncol. 2006;  32(2) 162-167
• 11 Habr-Gama A, Perez R O, Kiss D R et al.. Preoperative chemoradiation therapy for low rectal cancer. Impact on downstaging and sphincter-saving operations.  Hepatogastroenterology. 2004;  51(60) 1703-1707
• 12 Janjan N A, Khoo V S, Abbruzzese J et al.. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M.D. Anderson Cancer Center experience.  Int J Radiat Oncol Biol Phys. 1999;  44(5) 1027-1038
• 13 Fazio V W, Fletcher J, Montague D. Prospective study of the effect of resection of the rectum on male sexual function.  World J Surg. 1980;  4(2) 149-152
• 14 Hendren S K, O'Connor B I, Liu M et al.. Prevalence of male and female dysfunction is high following surgery for rectal cancer.  Ann Surg. 2005;  242(2) 212-223
• 15 Bokey E L, Chapuis P H, Fung C et al.. Postoperative morbidity and mortality following resection of the colon and rectum for cancer.  Dis Colon Rectum. 1995;  38(5) 480-486
• 16 Sterk P, Shekarriz B, Gunter S et al.. Voiding and sexual dysfunction after deep pelvic resection and total mesorectal excision: prospective study on 52 patients.  Int J Colorectal Dis. 2005;  20(5) 423-427
• 17 Williamson M E, Lewis W G, Finan P J, Miller A S, Holdsworth P J, Johnston D. Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma: myth or reality?.  Dis Colon Rectum. 1995;  38(4) 411-418
• 18 Heriot A G, Tekkis P P, Fazio V W, Neary P, Lavery I C. Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer: a predictive model.  Ann Surg. 2005;  242(4) 502-510
• 19 Weakley F L. Cancer of the rectum: a review of surgical options.  Surg Clin North Am. 1983;  63 129-135
• 20 Ota D M, Nelson H. ACOSOG Group Co-Chairs . Local excision of rectal cancer revisited: ACOSOG Protocol Z6041.  Ann Surg Oncol. 2007;  14(2) 271
• 21 Madbouly K M, Remzi F H, Erkek B A et al.. Recurrence after transanal excision of T1 rectal cancer: Should we be concerned?.  Dis Colon Rectum. 2005;  48(4) 711-721
• 22 Mellgren A, Sirivongs P, Rothenberger D A, Madoff R D, Garcia-Aguilar J. Is local excision adequate therapy for early rectal cancer?.  Dis Colon Rectum. 2000;  43 1064-1074
• 23 Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff R D, Rothenberger D A. Local excision of rectal cancer without adjuvant therapy: a word of caution.  Ann Surg. 2000;  231 345-351
• 24 Taylor R H, Hay J H, Larsson S N. Transanal local excision of selected low rectal cancers.  Am J Surg. 1998;  175 360-363
• 25 Romano G, deRosa P, Vallone G et al.. Intrarectal ultrasound and computed tomography in the pre- and post-operative assessment of patients with rectal cancer.  Br J Surg. 1985;  72(s) S117-S119
• 26 Rifkin M D, McGlynn E T, Marks G. Endorectal sonographic prospective staging of rectal cancer.  Scand J Gastroenterol Suppl. 1986;  123 99-103
• 27 Beynon J, Foy D M, Roe A M, Temple L N, Mortensen N J. Endoluminal ultrasound in the assessment of local invasion in rectal cancer.  Br J Surg. 1986;  73(6) 474-477
• 28 Blumberg D, Paty P B, Guillem J G et al.. All patients with small intramural rectal cancers are at risk for lymph node metastasis.  Dis Colon Rectum. 1999;  42(7) 881-885
• 29 Sitzler P J, Seow-Choen F, Ho Y H, Leong A P. Lymph node involvement and tumor depth in rectal cancers: an analysis of 805 patients.  Dis Colon Rectum. 1997;  40 1472-1476
• 30 Killingback M. Local excision of carcinoma of the rectum: indications.  World J Surg. 1992;  16(3) 437-446
• 31 Minsky B D, Rich T, Recht A, Harvey W, Mies C. Selection criteria for local excision with or without adjuvant radiation therapy for rectal cancer.  Cancer. 1989;  63 1421-1429
• 32 Brodsky J T, Richard G K, Cohen A M, Minsky B D. Variables correlated with the risk of lymph node metastasis in early rectal cancer.  Cancer. 1992;  69 322-326
• 33 Morson B C. Factors influencing the prognosis of early cancer of the rectum.  Proc R Soc Med. 1966;  59 607-608
• 34 Byrne J. Electrocautery in Uterine Surgery. New York, NY; William Wood and Co. 1889
• 35 Strauss A A, Strauss S F, Crawford R A, Strauss H A. Surgical diathermy of carcinoma of the rectum: It's clinical end results.  JAMA. 1935;  104 1480
• 36 Madden J L, Kandalaft S I. Electrocoagulation as a primary curative method in the treatment of carcinoma of the rectum.  Surg Gynecol Obstet. 1983;  157 164-179
• 37 Crile G, Turnbull R B. The role of electrocoagulation in the treatment of carcinoma of the rectum.  Surg Gynecol Obstet. 1972;  135 391-396
• 38 Salvati E P, Rubin R J. Electrocoagulation as primary therapy for rectal carcinoma.  Am J Surg. 1976;  132 583-586
• 39 Wilk P J, Turnbull R B. Local therapy for treatment of rectal cancer. In: Goldsmith H Practice of Surgery. Hagerstown, PA; Harper & Row 1980
• 40 Eisenstat T E, Oliver G C. Electrocoagulation for adenocarcinoma of the low rectum.  World J Surg. 1992;  16 458-462
• 41 Papillon J. Endocavitary irradiation of early rectal cancer for cure: A series of 123 cases.  Proc R Soc Med. 1973;  66 1179
• 42 Schild S E, Martenson J A, Gunderson L L. Endocavitary radiotherapy of rectal cancer.  Int J Radiat Oncol Biol Phys. 1996;  34 677-682
• 43 Reed W P, Cataldo P A, Garb J L et al.. The influence of local tumor ulceration on the effectiveness of endocavitary radiation for patients with early rectal carcinoma.  Cancer. 1995;  76 967-971
• 44 Hull TL . Lavery IC, Saxton JP. Endocavitary irradiation: an option for select patients with rectal cancer.  Dis Colon Rectum. 1994;  37 1266-1270
• 45 Parturier-Albot M. Statistics on 2045 cases of cancer of the rectum treated with contact radiotherapy with 5- to 30-year remission.  Bull Acad Natl Med. 1981;  165 967-974
• 46 Papillon J, Berard P. Endocavitary irradiation in the conservative treatment of adenocarcinoma of the low rectum.  World J Surg. 1992;  16 451-457
• 47 Sischy B, Hinson E J, Wilkinson D R. Definitive radiation therapy for selected cancer of the rectum.  Br J Surg. 1988;  75 901-903
• 48 Lavery I C, Jones I T, Weakley F L, Saxton J P, Fazio V W, Jagelman D G. Definitive management of rectal cancer by contact (endocavitary) irradiation.  Dis Colon Rectum. 1987;  30 835-838
• 49 Kovalic J J. Endocavitary irradiation for rectal cancer and villous adenomas.  Int J Radiat Oncol Biol Phys. 1988;  14 261-264
• 50 Gall F P, Hermanek P. Update of the German experience with local excision of rectal cancer.  Surg Oncol Clin North Am. 1992;  1 99-109
• 51 Willett C G, Compton C C, Shellito P C, Efird J T. Selection factors for local excision or abdominoperineal resection of early stage rectal cancer.  Cancer. 1994;  73 2716-2720
• 52 Buess G F, Raestrup H. Transanal endoscopic microsurgery.  Surg Oncol Clin North Am. 2001;  10(3) 709-731
• 53 Mentges B, Buess G F, Schafer D, Manncke K, Becker H D. Local therapy of rectal tumors.  Dis Colon Rectum. 1996;  39 886-892
• 54 Floyd N D, Saclarides T J. Transanal endoscopic microsurgical resection of pT1 rectal tumors.  Dis Colon Rectum. 2006;  49 164-168
• 55 Winde G, Nottberg H, Keller R et al.. Surgical cure for early rectal carcinomas (T1).  Dis Colon Rectum. 1996;  39 969-976
• 56 Middleton P F, Sutherland L M, Maddern G J. Transanal endoscopic microsurgery: a systematic review.  Dis Colon Rectum. 2005;  48 270-284
• 57 Rich T A, Weiss D R, Mies C et al.. Sphincter preservation in patients with low rectal cancer treated with radiation therapy with or without local excision or fulguration.  Radiology. 1985;  156 527-531
• 58 Mendenhall W M, Rout R, Zlotecki R A, Mitchell S E, Marsh D M, Copeland E M. Conservative treatment of rectal adenocarcinoma.  Hemat/Oncol Clin North Am. 2001;  15(2) 303-319
• 59 Quan S H, Deddish M R, Stearns M W. The effect of preoperative roentgen therapy upon ten and five year results of surgical treatment of cancer of rectum.  Surg Gynecol Obstet. 1960;  111 507-508
• 60 Marks G, Mohiuddin M M, Masoni L, Pecchioli L. High-dose preoperative radiation and full-thickness local excision. A new option for patients with select cancers of the rectum.  Dis Colon Rectum. 1990;  33(9) 735-739
• 61 Habr-Gama A, Perez R O, Nadalin W et al.. Operative versus nonoperative treatment for Stage 0 distal rectal cancer following chemoradiation therapy: long-term results.  Ann Surg. 2004;  240(4) 711-718
• 62 Nigro N D, Vaitkevicius V K, Considine B. Combined therapy for cancer of the anal canal: a preliminary report.  Dis Colon Rectum. 1974;  17(3) 354-356