When is local excision appropriate for “early” rectal cancer?

Abstract

Local excision is increasingly performed for “early stage” rectal cancer in the US; however, local recurrence after local excision has become a controversial issue in Western countries. Local recurrence is considered to originate based on the type of tumor and procedure performed, and in surgical margin-positive cases. This review focuses on the inclusion criteria of “early” rectal cancers for local excision from the Western and Japanese points of view. “Early” rectal cancer is defined as T1 cancer in the rectum. Only the tumor grade and depth of invasion are the “high risk” factors which can be evaluated before treatment. T1 cancers with sm1 or submucosal invasion <1,000 μm are considered to be “low risk” tumors with less than 3.2 % nodal involvement, and are considered to be candidates for local excision as the sole curative surgery. Tumors with a poor tumor grade should be excluded from local excision. Digital examination, endoscopy or proctoscopy with biopsy, a barium enema study and endorectal ultrasonography are useful for identifying “low risk” or excluding “high risk” factors preoperatively for a comprehensive diagnosis. The selection of an initial local treatment modality is also considered to be important according to the analysis of the nodal involvement rate after initial local treatment and after radical surgery.

Current status of local treatment for early rectal cancer in Japan: a questionnaire survey by the 81st Congress of the Japanese Society for Cancer of the Colon and Rectum (JSCCR) in 2014

“…Validation studies are required to confirm its efficacy for ERC. in a review article, Maeda et al [22] reported that the appropriate goal of LE for T1 RC as a sole curative surgery is to acquire a comparable LRR to that of radical surgery or a nodal involvement rate of T1 by selecting the appropriate tumor type and surgical procedure.…”

Features of Late Recurrence Following Transanal Local Excision for Early Rectal Cancer

“…7,8 however, some publications have defined ptis and pt1 to be early rectal cancers. 6,9 several reports have confirmed that, as a clinically applicable modality, tae of ptis and select pt1 rectal cancers has shown oncologic outcomes similar to radical surgery. 5,10 however, local and systemic recurrences of ptis and pt1 rectal cancers following tae have been reported.…”

“…in addition, it has been associated with shorter hospital stays and low morbidity and mortality rates. 2,5,6 early rectal cancer is usually defined as pt1 and pt2 in many Western countries. 7,8 however, some publications have defined ptis and pt1 to be early rectal cancers.…”

Preoperative chemoradiotherapy followed by transanal local excision for T3 distal rectal cancer: A case report

“…The standard surgical procedure for the treatment of rectal cancer is abdominoperineal resection, low anterior resection or resection with coloanal anastomosis (3). However, local excision (LE) has been regarded as an alternative method for selected cases that fulfill stringent conditions of small-sized T1 tumors with no unfavorable histological features (4). LE has advantages in rapid postoperative recovery, avoiding sphincter ablation (permanent colostomy) and morbidities associated with radical resection, such as urinary and sexual dysfunction (4).…”