Local resection in rectal cancer: When, who and how?

Area of Science:

• Colorectal surgery
• Oncology
• Surgical innovation

Background:

• Local resection (LR) is suitable for specific early-stage rectal cancers (T1N0M0) using transanal endoscopic surgery.
• Standard treatment for more advanced stages (T2N0M0) or T1 with poor prognostic factors is total mesorectal excision (TME).
• TME is associated with significant postoperative morbidity, mortality, and reduced quality of life.

Purpose of the Study:

• To explore organ-preservation strategies as alternatives to total mesorectal excision (TME) in rectal cancer treatment.
• To evaluate the potential of neoadjuvant therapy combined with local resection.
• To investigate the feasibility of a neoadjuvant therapy followed by a
• Watch and Wait
• approach for complete clinical response cases.

Main Methods:

• Accurate tumor staging and patient selection are critical initial steps.
• Review of outcomes for local resection (LR) in early rectal cancer.
• Exploration of neoadjuvant therapies in conjunction with LR or surveillance strategies.

Main Results:

• Local resection (LR) can achieve oncologically satisfactory outcomes for selected T1N0M0 rectal cancers.
• Neoadjuvant therapy combined with LR shows promising results.
• The "Watch and Wait" approach following neoadjuvant therapy is a potential future strategy for complete responders, though challenges remain.

Conclusions:

• Accurate staging and selection are paramount for successful local resection in rectal cancer.
• Organ-preservation strategies, including neoadjuvant therapy with LR or "Watch and Wait," offer promising alternatives to TME.
• Further research is needed to address challenges in implementing these novel approaches for rectal cancer management.