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Management of early rectal cancer; current surgical options and future direction
Vijay Chavda1, Oliver Siaw1, Sanjay Chaudhri1
1Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom.
Abstract:
Rectal cancer is the second commonest cause of cancer death within the United Kingdom. Utilization of national screening programmes have resulted in a greater proportion of patients presenting with early-stage disease. The technique of transanal endoscopic microsurgery was first described in 1984 following which further options for local excision have emerged with transanal endoscopic operation and, more recently, transanal minimally invasive surgery. Owing to the risks of local recurrence, the current role of minimally invasive techniques for local excision in the management of rectal cancer is limited to the treatment of pre-invasive disease and low risk early-stage rectal cancer (T1N0M0 disease). The roles of chemotherapy and radiotherapy for the management of early rectal cancer are yet to be fully established. However, results of high-quality research such as the GRECCAR II, TESAR and STAR-TREC randomised control trials may highlight a wider role for local excision surgery in the future, when used in combination with oncological therapies. The aim of our review is to provide an overview in the current management of early rectal cancer, the surgical options available for local excision and the future multimodal direction of early rectal cancer treatment.
Insights
Early rectal cancer detection is increasing due to screening. Minimally invasive local excision is currently limited, but future multimodal treatments may expand its role in rectal cancer management.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Research
Background:
- Rectal cancer is a leading cause of cancer mortality in the UK.
- National screening programs increase early-stage rectal cancer diagnoses.
- Advancements in local excision techniques include transanal endoscopic microsurgery, transanal endoscopic operation, and transanal minimally invasive surgery.
Purpose of the Study:
- To review current management strategies for early rectal cancer.
- To outline available surgical options for local excision.
- To discuss the future multimodal treatment directions for early rectal cancer.
Main Methods:
- Literature review of current management practices.
- Analysis of surgical techniques for local excision.
- Evaluation of ongoing and recent clinical trials (e.g., GRECCAR II, TESAR, STAR-TREC).
Main Results:
- Minimally invasive local excision is currently restricted to pre-invasive and low-risk T1N0M0 rectal cancer due to local recurrence risks.
- The roles of chemotherapy and radiotherapy in early rectal cancer remain under investigation.
- Emerging research suggests potential for expanded local excision roles when combined with other therapies.
Conclusions:
- Current management of early rectal cancer involves local excision for select cases.
- Future treatment paradigms may involve multimodal approaches combining surgery with chemotherapy and/or radiotherapy.
- Ongoing research is crucial for defining the optimal role of local excision in early rectal cancer management.
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