Is surgery-only the adequate treatment approach for T2N0 rectal cancer?

Background and Objectives: Resection combined with standard lymphadenectomy is generally recommended for T2NO rectal cancer. In order to evaluate the outcome of this specific tumor category, our own data were reviewed. Methods: To evaluate the results of patients with curative resected T2NO rectal carcinoma, we reviewed data of 164 consecutive patients with adenocarcinoma of the rectum between 198 1 and 2003 in our department. In addition, patient characteristics were stratified according to the position of the rectal tumor with respect to the anal verge. Results: One hundred ten patients (67.1%) underwent anterior resection and 54 patients (32.9%) received abdominoperineal amputation. The follow-up revealed 6 local recurrences (3.7%); in 10 patients (10.0%), metastases were discovered. Regarding the tumor localization nearly no local recurrence or distant metastases were observed in the middle or the upper rectum. However, in the lower rectum the actuarial 5-year recurrence rate was 16.2%. Conclusions: Although T2NO rectal carcinomas are considered as low risk tumors, we found a considerable local recurrence rate of 3.7%. The question arises whether this result can be improved by adjuvant treatment modalities without being compromised by the toxicity of an adjuvant treatment.