Local treatment of carcinoma of the rectum

LE is a management modality offered, at present, to less than 5 per cent of all patients with carcinoma of the rectum. It is indicated, as a primary curative procedure, in the subgroup of patients with early lesions of a favorable histologic grade. It has also been used, for palliation, in patients with overt disseminated malignant disease or in patients too old or too ill, or both, to withstand a radical operation or unwilling to accept a colostomy. Various techniques have been described and can be divided into two categories: excision of the intact tumor, best suited for a curative procedure when tumor characteristics can be accurately determined, and tumor destruction therapy, more generally used for palliation. The results of local excision, compared with those of radical operations, are very good when a strict selection policy is implemented and coupled with adequate patient follow-up study.