Early rectal cancer: local excision or radical surgery?

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Rectal Cancer Treatment

Background:

• Rectal cancer treatment prioritizes sphincter preservation, disease control, and long-term survival.
• Transanal local excision is a sphincter-sparing option, but its efficacy compared to radical surgery is debated.
• Early-stage rectal tumors present a specific challenge for treatment modality selection.

Purpose of the Study:

• To compare treatment outcomes of transanal local excision versus radical surgery for rectal cancer.
• To evaluate recurrence and survival rates based on existing literature.
• To assess the success of salvage surgery following local excision.

Main Methods:

• A comprehensive literature review was conducted using PubMed.
• Studies published within the last 10 years were analyzed.
• Ten non-randomized studies, including prospective, comparative, and case reports, were identified.

Main Results:

• Five-year overall survival rates were 69-83% for local excision and 82-90% for radical excision.
• Local recurrence rates were 9-20% for local excision versus 2-9% for radical surgery.
• Systemic recurrence rates were 6-21% for local excision and 2-9% for radical surgery.

Conclusions:

• Radical surgery provides more definitive treatment for rectal cancer.
• Transanal local excision remains a viable option for select patients, balancing reduced morbidity with increased recurrence risk.
• Patients undergoing local excision require extended postoperative surveillance and may have lower salvage surgery success rates.