The role of surgical local excision in the treatment of rectal cancer.

Selection of patients with ulcerating rectal cancer for treatment by local excision has been governed by a policy based on clinical and histological criteria; if these criteria are not fulfilled, major resection is recommended. This policy was re-examined in three groups of patients treated by local excision: Group 1 for cure (27 patients), Group 2 due to unfitness for major surgery (13 patients), Group 3 for local tumour control in the presence of metastatic disease (6 patients). When the policy was fulfilled, there was a cancer-specific death rate of 8.3 per cent in Group 1 (two patients with poorly differentiated tumours) and 0 per cent in Group 2. Unavoidable policy breaches occurred when patients refused major surgery or were too unfit: in the latter elderly group, this did not have the adverse effect expected. It is concluded that pre-operative clinical digital assessment and histological grading are a satisfactory means of identifying a small group of tumours appropriate for local treatment and that the results justify local excision where the policy is observed.