Establishing a Standard for Treating Flat Early Cancers of the Rectum

Shu Kuramoto, Kaoru Kobayashi, Toshiki Mimura, Kazuki Yamasaki, Masanori Hashimoto, Shigeru Sakai, Michio Kaminishi, Takeshi Oohara

The Third Department of Surgery, University of Tokyo

The treatment of flat early cancers of the rectum represents a subject of considerable dabate. We investigated lesion types, postoperative complications and the courses of 41 cases of flat early rectal cancers encountered from January 1985 to November 1995. These cancers were treated utilizing our preferred standard of treatment. This standard can be outlined as follows: (a) mucosal cancers under 20 mm in diameter should be treated endoscopically; (b) mucosal cancers over 20 mm and cancers involving the submucosal layer except Type B should be surgically resected, omitting lymph node dissection; but (c) Type B requires lymph node dissection. Clinicopathological features were as follows: male 23, female 18; depth m 20, depth sm 21; average age 61.5 years; Elevated type with depression, Type B indicating that moderately differentiated adenocarcinoma massively involves the submucosal layer. Of the mucosal cancers, only one involving the dentate line necessitated resection by rectal amputation; the others were treated while preserving anal function. Treatments for cancers involving the submucosal layer and number of relevant cases were endoscopic resection (3); posterior approaches (4); low anterior resection (4) sacro-abdomino-sacral resection (4); and rectal amputation (4). The last four types of operations included lymph node dissection. Only one recurrence was observed among Type B treated by low anterior resection with D₃ dissection. The other operations, whether omitting or including lymph node dissection, were successful. Frequent use of posterior approaches is useful for treating flat early cancers of the lower rectum while preserving anal function without increasing the recurrence rate.

Key words
flat cancer, rectal cancer, posterior approach

Reprint requests
Shu Kuramoto The Third Department of Surgery, University of Tokyo
3-28-6 Mejirodai, Bunkyo-ku, Tokyo, 112 JAPAN

Accepted
December 11, 1996

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