Posterior trans-sphincteric resection for small tumours of the lower rectum.

In the period 1977-1983, 21 patients with small tumour of the lower two-thirds of the rectum were treated with local excision, using the posterior trans-sphincteric approach. The operative and postoperative course was uneventful, with no mortality, septic complications, fistula or anal incontinence. In 14 cases the tumour was an adenocarcinoma. These tumours had been preoperatively classified as carcinoma or suspected carcinoma with limited superficial growth. In 12 of them there was no invasion beyond the rectal wall. In follow-up averaging 44 months there has been no local recurrence, but liver metastasis has appeared in two patients. In our experience, local tumour excision via posterior trans-sphincteric rectotomy is a safe alternative for removal of adenoma or small, localized carcinoma of the lower two-thirds of the rectum.