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Updated: Aug 11, 2026
The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors
Published on: February 13, 2026
Local excision of stratified T1 rectal cancer
Kelly Wirsing1, Shauna Lorenzo-Rivero, Martin Luchtefeld
1Department of Colon and Rectal Surgery, Spectrum Health-Blodgett Campus, Grand Rapids, MI, USA. kellywir@aol.com
Background:
Local excision has been accepted therapy for T1 rectal cancers. A recent study demonstrated that primary tumors with deeper submucosal invasion were associated with a higher rate of lymph node metastases than those with shallow invasion. Our aim was to determine the effect of the depth of submucosal penetration on recurrence and mortality rates following transrectal excision of T1 tumors.
Methods:
This was a 34-year retrospective review of patients who had transrectal excision with clear margins for T1 rectal cancer. Tumors were stratified into submucosal (SM) levels, and recurrence and mortality rates were determined.
Results:
Of 101 patients with T1 rectal cancer undergoing local excision, 31 had a full-thickness transrectal excision. Eight (26%) of the 31 patients developed a local recurrence, 2 of whom had both a local and distant recurrence. Four patients (13%) died from metastatic rectal cancer.
Conclusions:
The recurrence rate for transrectal excision of T1 rectal cancer is high. It may be beneficial for patients with early rectal cancer to have postoperative chemoradiation therapy or a more radical surgical procedure.
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