Extended Full-thickness Transanal Excision for Ultra-low Rectal Cancer: an Initial Clinical Exploration

Transanal local excision is an acceptable curative operation for selected small low-risk T1 low rectal cancer (Blackstock et al., 2010; You et al., 2007). Recently increasing evidence has implied that preceded by adjuvant chemoradiotherapy transanal local excision may be an alternative curative procedure for small T2 and even T3 low rectal cancer that responds well to neoadjuvant therapy (Bujko et al., 2007; Park et al., 2007; Borschitz et al., 2008; Lezoche et al., 2008; Callender et al., 2010). For those who can not tolerate radical resection and those who do not accept colostomy, transanal local excision can serve as a palliative operation. For ultra-low rectal cancer that invading the anorectal junction with tumor infiltrating upper anal canal, the anorectal wall beneath is wrapped by little or no mesorectal tissue. In this circumstance conventional full-thickness resection will has a limited deep radial resection margin, which may be insufficient for tumors infiltrating deep into or out of the longitudinal muscle. We have performed extended full-thickness transanal local excision which extended the dissection plane from the intersphincteric plane to the striated musculature layer.