Local therapy for rectal cancer: still controversial?

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Local therapy for rectal cancer is increasingly favored over radical surgery due to lower rates of morbidity, sexual dysfunction, and the need for a permanent stoma.
• Despite its growing popularity, the oncologic efficacy of local therapy for curative intent remains a subject of debate, with some studies reporting inferior long-term results compared to radical surgery.

Purpose of the Study:

• To review the current evidence on local therapy for rectal cancer, focusing on oncologic outcomes and patient selection criteria.
• To evaluate the role of novel treatment strategies, including neoadjuvant and adjuvant therapies, in the management of rectal cancer.

Main Methods:

• A comprehensive literature search was conducted across MEDLINE, EMBASE, LILACS, and abstract books.
• The review included English-language publications, with a specific focus on studies examining oncologic results and patient selection for local rectal cancer therapy.

Main Results:

• Patient selection, based on preoperative tumor staging and favorable clinical/pathologic features, is paramount for potentially curative local treatment.
• Low-risk T1 rectal tumors are suitable for local excision alone.
• Adjuvant chemoradiotherapy may benefit patients with unfavorable T1 and T2 lesions, potentially reducing local recurrence rates to below 20%.

Conclusions:

• Careful patient selection is essential for successful curative-intent local therapy in rectal cancer.
• Local excision is a viable option for select low-risk T1 tumors.
• The role and efficacy of salvage surgery following local excision for rectal cancer require further investigation.