Two Rational Conservative Operations for Early Cancers of the Lower Rectum -Especially Local Resection of the Rectum with Wide (Regional) Mesorectal Excision-

Kaoru Azekura, Masaki Akada, Tsutomu Masuda, Masashi Ueno, Hirotoshi Ohta, Takashi Takahashi, Kiyoko Kubo*, Akio Yanagisawa*, Yo Kato*

Department of Gastroenterological Surgery, Cancer Institute Hospital
*Department of Pathology, Cancer Institute

Nine cases with an early cancer of the low rectum underwent surgery using two rational conservative surgical procedures; namely, transanal mucosal resection (TMR) and local resection with wide (regional) mesorectal excision (WM method of local resection). In TMR (the same as the procedure used by Parks), the tumor is dissected in one piece with a disk of mucosa leaving exposed circular muscle, and cancers of M´ to SM´ slight invasion in the preoperative depth evaluation are indication for this operation. Submucosal cancer is subdivided according to Kato's classification (sm1, sm2 and sm3). After TMR the m to sm1 cancers are followed endoscopically and the sm2 cancers undergo additional radical surgery. Three of the four cases in which depths of cancer invasion were corrected after TMR and could undergo rational treatments. With this new operative procedure, "WM method of local resection", cancer is excised with a margin of 10 mm or less adding a wide (100 mm or more orally) mesorectal dissection. This procedure is indicated for sm2 cancer. Five cases were operated on using this method; one case with positive nodes also underwent APR. No recurrence was recognized in the mean follow-up term of 17 months.

Key words
rectal cancer, mesorectal excision, local excision of the rectum

Reprint requests
Kaoru Azekura Department of Surgery, Cancer Institute Hospital
1-37-1 Kami-ikebukuro, Toshima-ku, Tokyo, 170 JAPAN

Accepted
December 11, 1996

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