[Pros and cons of local excision procedures for early rectal cancer]

The most appropriate technique for local excision of early rectal cancer remains controversial. Surgeons are responsible for determining whether the intent of treatment is curative or palliative and which technique to employ. The aim of local excision is to perform full-thickness resection of early rectal cancer with sufficient surgical margins for pathologic study. Patients in whom lymph node metastasis is suspected should undergo additional surgery. Various procedures have been reported so far. Local excision techniques are currently most often performed via the transanal approach under direct visualization, which include conventional techniques and minimally invasive transanal surgery (MITAS), or transanal endoscopic microsurgery (TEM). MITAS and TEM provide access to more proximal tumors up to 20cm from the anal verge. While posterior approaches are useful to expose the rectal wall to facilitate local excision, these procedures are infrequently performed at present due to the significant associated morbidity, such as bowel fistulas and impaired anorectal function. In conclusion, it is essential to recognize the pros and cons of the various techniques when performing local excision for early rectal cancer.