Surgical Treatment for Early Rectal Cancer

Yojiro Hashiguchi^{1) 2)}, Takeshi Sekine¹⁾, Takashi Migita¹⁾, Hirohiko Sakamoto¹⁾ and Yoichi Tanaka¹⁾

¹⁾Division of Abdominal Surgery Clinic, Saitama Cancer Center
²⁾Department of Surgery I, National Defense Medical College

In the present study we first analyzed the clinicopathological features of early rectal cancer to define the basic surgical treatment policy for the disease. Then we assessed the factors which did not conform to the policy. The subjects included 74 patients with early rectal cancer (38 mucosal cancer, and 36 submucosal cancer). The sm cancers were divided into three categories according to the degree of cancerous invasion in the submucosa (sm₁,sm₂,and sm₃). Early rectal cancer witrh massive invasion (sm₂+sm₃) had much more lymphatic and venous invasion, and more moderately differentiated carcinoma than those with slight invasion (m+sm₁). Thus, we developed a policy that cancer with massive invasion should be treated by radical surgery, whereas that with slight invasion should undergo local excision. Our study revealed that 28% of the patients underwent excessive surgery, whereas 9% were treated by insufficient surgery based on the above policy. One half of early cancer cases of superficial type were treated inappropriately. Furthermore, 55% of large early cancers (≥3.0 cm in diameter) underwent excessive surgery. Surgical treatment should be carefully selected for early rectal cancer of superficial type and/or of large size.

Key words
early rectal cancer, local excision, submucosal invasive carcinoma, superficial carcinoma

Reprint requests
Yojiro Hashiguchi Department of Surgery I, National Defense Medical College 3-2Namiki, Tokorozawa, 359-8513 JAPAN

Accepted
February 23, 2000

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