Cancer of the rectum--local excision

Limited surgical techniques have gained an important role among treatment modalities for invasive carcinoma of the rectum. Polypoid or plateau-like tumors not larger than 3 cm in which palpation, CT, and endoluminal sonography findings suggest only a slight depth of invasion may be treated by limited surgery. According to tumor size, macroscopic appearance, and site, one can decide whether to choose endoscopic polypectomy, per anal submucosal or full-thickness disc excision, or trans-sphincteric excision. After local excision, careful pathologic examination of the specimen is essential in deciding whether the limited procedure can be regarded as curative or whether a radical resection must be added. When average operative risk is present, carcinomas limited to the submucosa (pT1 or early carcinomas) with good prognostic histomorphologic features (grade 1 or 2; no lymphatic invasion) are suitable for treatment by limited surgery. If strict selection criteria are implemented, 5-year survival rates of better than 90 per cent can be achieved. The complication rate is low, and the postoperative mortality rate, even in elderly patients, is minimal.