Abstracts
1999 Digestive Disease Week

# 2078 ENDORECTAL ULTRASONOGRAPHY AND TREATMENT OF EARLY RECTAL CANCER
Takayuki Akasu, Hitoshi Kondo, Takuji Gotoda, Shin Fujita, National Cancer Ctr Hosp, Tokyo Japan; Kenichi Sugihra, Tokyo Med and Dental Univ, Tokyo Japan; Yoshihiro Moriya, National Cancer Ctr Hosp, Tokyo Japan

PURPOSE:To evaluate the accuracy of staging by EUS and its role in selection of treatment in early rectal cancer.
MATERIALS AND METHODS: Results of EUS for 154 patients (pts) with early rectal cancers (pTis or pT1) or pT2 tumors were compared prospectively with histologic findings (TNM classification). Results of treatment selection and long-term outcomes were analyzed retrospectively.
RESULTS:35 pts were histologically staged as pTis, 8 as pT1-slight (invasion confined to the superficial one third of the submucosa), 37 as pT1-massive (invasion into the deeper submucosa), and 74 as pT2. Sensitivity/specificity/overall accuracy rate for detection of pT1-slight, pT1-massive, and pT2 were 99%/74%/96%, 98%/88%/97%, and 97%/93%/96%, respectively. Incidences of Lymph node involvement in pTis, pTis-pT1-slight, pT1, pT1-massive and pT2 pts were 0%, 0%, 18%, 22% and 30%, respectively. Sensitivity, specificity, and overall accuracy rate for detection of lymph node metastasis were 53%, 77%, and 72%, respectively. Of the 43 pts with pTis to pT1-slight tumors, 22 underwent endoscopic polypectomy (EP) or local excision (LE) alone, 20 radical surgery (RS) alone, and 1 RS after EP due to vascular invasion. All these pts are alive and all but one who denied RS after LE in spite of vascular invasion and developped liver metastases are disease-free. Of the 37 pts with pT1-massive tumors, 34 underwent RS and 3 transcoccygeal segmental resection. All these pts are alive disease-free except for 1 who died of peritoneal carcinomatosis after RS. Overall 5-year survival rates for pTis, pT1, and pT2 pts were 100%, 98%, and 97%, respectively.
CONCLUSIONS: Pts with Tis or T1-slight tumors by EUS are at low risk for lymph node metastasis and good candidates for EP or LE. But pts with T1-massive by EUS should be treated with RS because of high incidence of lymph node metastasis.

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