A Retrospective Comparison of Transanal Surgery and Endocavitary Radiation for the Treatment of 'Early' Rectal Adenocarcinoma

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Abstract
Objective: To compare two techniques for the local treatment of "early" rectal adenocarcinoma. Design and Study Participants: A retrospective comparison of 27 patients who underwent transanal disk excision and fulguration (group A) and 38 patients who underwent transanal endocavitary radiation (group B). Setting: Inpatient and outpatient. Intervention: Group A patients had rectal adenocarcinoma treated with disk excision and fulguration. Group B patients received 100 to 125 Gy in four to five fractions using the Phillips RT-50 unit. Main Outcome Measures: Survival and local recurrence. Results: The median follow-up for group A was 68 months; for group B, 38 months. The mean tumor diameter was 2.5 cm, all were grade 1 or 2. The local recurrence rate was 7.4% for group A and 21% for group B. Local recurrence was not correlated with tumor grade, location, or size but did correlate with tumor ulceration. Conclusion: For selected early rectal cancers, surgical excision and fulguration offers better local control than endocavitary radiation therapy, while survival was similar. (Arch Surg. 1993;128:1028-1032)