Importance of patient selection in local treatment of carcinoma of the rectum.

Fifty-eight patients with potentially curative adenocarcinomas of the rectum underwent fulguration of their tumors without regard to size of the lesion. The overall 5 year survival rate was 48.3 percent. However, if patients with adenocarcinomas that arose in villous adenomas were excluded, the 5 year survival rate dropped to 31.7 percent. Of the six patients with a carcinoma less than 3 cm in diameter, the 5 year survival rate was 83 percent. Of the 30 patients with lesions 3 cm or larger, the 5 year survival rate was 23.3 percent. No patient with a lesion larger than 4 cm was cured. It is believed that patients with small adenocarcinomas (less than 3 cm) have a better chance of cure with fulguration than with radical surgery. Cancers between 3 and 4 cm may be treated successfully by local means. Fulguration of rectal carcinomas should not be performed in patients with lesions larger than 4 cm in diameter, except for palliation or in those who refuse permanent colostomy.