Early-stage XXXX : electrofulguration in comparison to abdominoperineal extirpation or low-anterior resection.

@entity1 @entity5 @entity260 @entity583 @entity420 @entity1756
For some small @entity5 electrofulguration can be an attractive alternative to more extensive surgical procedures. This report is a review of 49 @entity1 who, after careful selection, were considered ideal candidates for curative fulguration in the period 1959-1982. All had @entity420 and were clinically staged as Dukes' @entity5 . To put the results of this analysis into perspective, they are compared to the results of those @entity1 (34) who also had early clinical stage @entity420 , but for a variety of reasons underwent abdominoperineal excisions (APE, 11 @entity1 ) or low-anterior resections (LAR, 23 @entity1 ) instead of fulguration. @entity260 after fulguration were minimal, there were no postoperative deaths, and all @entity1 retained anal continence. After APE or LAR there were two postoperative deaths (one @entity583 , one @entity1756 ); postoperative morbidity was greater. All LAR-treated @entity1 remained continent. Of the @entity1 at risk 55% remained disease-free after fulguration, while 77% remained disease-free after APE or LAR (P = 0.023). This is due to a higher percentage of loco-regional recurrences occurring after fulguration than after APE or LAR (31% vs 9%, respectively, P = 0.021). The percentage of @entity1 with distant metastases in both groups are similar. It seems that electrofulguration of @entity5 , even in strictly selected @entity1 in a specialized institution, can lead to an unacceptably high percentage of @entity1 with loco-regional recurrences. Nearly all local failures occurred in @entity1 with @entity5 that measured more than 3 cm in diameter and/or occupied more than one-third of the rectal circumference. Salvage operations for loco-regional failure were performed in 13 @entity1 , 5 of whom are alive with no evidence of disease. Since there seems to be a direct relation between @entity5 size and the chance of loco-regional recurrence and since salvage operations for local failure are not uniformly successful, electrofulguration for cure must be reserved for the very rare @entity1 with a very small early-stage @entity5 .
