Local Excision of Rectal Cancer: Conventional Wisdom and Traditional Techniques

Local techniques for excising or destroying rectal cancers had been practiced for decades, before the onset of radical proctectomy. The history and technical aspects of the various approaches are discussed. Indications for local excision are based on preoperative size, stage, and location. Local excision is also indicated in patients that refuse or will not tolerate radical surgery. Oncologic outcomes from the literature indicate that in select patients local excision is adequate and equivalent to more extensive surgery. Local recurrence and long-term survival are not significantly different. Immediate salvage surgery for understaged or inadequately excised tumors provides uncompromised oncologic results. However, performing radical surgery at the time of recurrence after local excision is not as effective as initial LAR/APR. Neoadjuvant treatment may provide adequate tumor reduction and downstaging to allow use of local excision in tumors previously not considered candidates.