Local Therapy for Rectal Cancer: Still Controversial?

Abstract

The key to potentially curative local treatment for rectal cancer is patient selection by identifying the best candidates with preoperative tumor staging and clinical and pathologic assessment of favorable features. Low-risk T1 is suitable for local excision alone. Limited data suggest that adjuvant chemoradiotherapy may be helpful in patients with unfavorable T1 and T2 lesions, achieving a local recurrence rate<20 percent. However, the efficacy of salvage surgery after local excision is uncertain.

Transanal Endoscopic Microsurgery is more Effective than Traditional Transanal Excision for Resection of Rectal Masses

“…For malignant lesions, TA has a 0 to 32 percent recurrence rate, [1][2][3]7 and TEM has yielded recurrence rates of 5 to 15 percent. 12,[23][24][25][26] Few studies have compared TEM to TA for malignant lesions.…”

“…It is now generally accepted that local excision is appropriate for benign lesions and possibly early rectal cancers with favorable histology. [1][2][3][4][5][6][7] The role of transanal endoscopic microsurgery (TEM) as a technique for local excision continues to be developed.…”

A prospective analysis of patient outcome following treatment of T3 rectal cancer with neo-adjuvant chemoradiotherapy and transanal excision

“…Recent advances in neo-adjuvant chemo/radiotherapy (CRXT) have led to consideration of rectal sparing surgery as there is evidence of comparable oncological outcomes following local resection compared with radical surgery following neo-adjuvant CRXT [3,21].…”

Oncological outcomes of transanal local excision for high risk T1rectal cancers

“…However, the main disadvantages of these radical procedures include significant mortality and morbidity, as well as the necessity of permanent colostomy that may not be warranted for early rectal cancers which may be treated with local excision [5,6] . With less intraoperative blood loss [7] , shorter length of hospital stay [8,9] , lower postoperative mortality and morbidity [10,11] , excellent maintenance of function [12,13] and avoidance of permanent colostomy [14,15] , the benefits of local excision compared to radical surgery are significant.…”

“…The role of local excision as a curative therapy in the treatment of patients with T1 rectal cancers is still controversial [16][17][18] . There is increasing evidence to suggest that local excision should be restricted to patients with low risk T1 rectal cancers [5,6,11,19] . In these strictly selected patients, local excision may be an acceptable alternative with equivalent oncological outcomes to radical surgery.…”