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Local Excision of Early-Stage Rectal Cancer

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Surgical Oncology

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Abstract

Early-stage rectal cancer, defined as T1–T2, N0, M0, is a curable disease, and the standard-of-care treatment is radical surgical resection (low anterior resection or abdominoperineal resection). Radical resection is associated with significant morbidity, prolonged recovery and compromised bowel, urological and sexual function, and risk of creation of a permanent colostomy, especially in patients with distal rectal cancer. Local excision is a “rectum-preserving,” functioning-maintaining procedure that is associated with low morbidity and mortality in highly selected patients. Local excision has evolved from “simple disc excision” of small tumors within reach performed under direct vision into a complex transanal excision of larger and more advanced proximal cancers. The indications for local excision have expanded to include patients with advanced rectal cancer for which significant response to neoadjuvant therapy has occurred. However, because of oncologic concern, such expansive inclusion must be viewed as investigational at this time. There are no randomized trials comparing oncologic outcomes between local excision and radical resection. Careful patient selection and possibly the use of adjuvant therapy may improve the results of local excision, although there are no phase III trials to support the role of adjuvant therapy. Local excision is reserved for highly select patients with T1 cancer or those whose comorbid conditions preclude a major operation.

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Authors and Affiliations

  1. Department of Surgery, LSUHSC-Shreveport, 3806 Richmond Ave., Shreveport, LA, USA

    Matthew Sanders BA, M.D.

  2. Department of General Surgery, University at Buffalo School of Medicine, 100 High Street, Buffalo, NY, USA

    Benjamin W. Vabi M.D.

  3. Department of Surgery, LSUHSC/University Health-Shreveport, 1501 Kings Hwy., Shreveport, LA, 71103, USA

    Phillip A. Cole M.D., MHCM, FACS, FASCRS

  4. Department of Surgery, Buffalo General Medical Center, University at Buffalo-State University of New York, 100 High Street, Buffalo, NY, 14203, USA

    Mahmoud N. Kulaylat M.D.

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  2. Benjamin W. Vabi M.D.
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  3. Phillip A. Cole M.D., MHCM, FACS, FASCRS
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Correspondence to Mahmoud N. Kulaylat M.D. .

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  1. Department of Surgery, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana, USA

    Quyen D. Chu

  2. Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey, USA

    John F. Gibbs

  3. John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, Louisiana, USA

    Gazi B. Zibari

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Sanders, M., Vabi, B.W., Cole, P.A., Kulaylat, M.N. (2015). Local Excision of Early-Stage Rectal Cancer. In: Chu, Q., Gibbs, J., Zibari, G. (eds) Surgical Oncology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1423-4_17

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