Transanal surgery for cT2T3 rectal cancer: Patient selection, adjuvant therapy, and outcomes

Local excision alone is not adapted for cT2T3 rectal cancer, because it is associated with a high local recurrence rate (23% for T2 and 38% for T3) and postoperative therapy after local excision is not efficient to prevent local recurrence. By contrast, neoadjuvant therapy proposes to permit local excision for cT2T3 because the patients are selected by the tumor response. Patients with cT2N0 and small cT3 tumors ≤4 cm are the best indications for this strategy. Local excision permits to select the good pathologic responders ypT0-1 as the optimal candidate for surveillance and to propose radical surgery for the bad responders. Retrospective series of local excision after neoadjuvant therapy for cT2T3 showed 7% local recurrence and 8% distant recurrence. These promising results will be validated after the long-term results of the multicenter trials.