[Local excision of rectal cancer in early phase as an alternative to major surgery]

The authors analyse the role of local excision as curative procedure of low rectal early cancer. In their opinion it's very important to select the patients in accordance with some characteristics of the tumor (site, grading, mobility, depth, size, stage, involvement of locoregional nodes, ploidia). Intrarectal ultrasonography is thought be the most important diagnostic tool, both in preoperative diagnosis and in postoperative follow-up; it has a high sensibility to define the parietal invasion of rectal cancer and to recognize metastatic nodes. They review various surgical techniques used to make local excision by several authors (transsacral approach by Kraske, transsphinteric approach by Mason and transanal approach by Bailey), as well as the alternative methods (surgical diathermy by Strauss, endocavitary irradiation by Papillon and cryosurgery by Heberer). The authors point out the technique of Bailey and coll. is getting the major approvals owing to its simplicity, low mortality and morbidity rates, poor incidence of recurrences and good survival. The most recent therapeutic protocols provide only local excision for the lesions limited into mucosa and submucosa (stage T1), also postoperative radio- and chemotherapy for tumors involving muscolaris propria (stage T2). On the other hand, advanced rectal cancer (stage T3) may be managed best by major operations. Recurrences rates (5-22%) and five-years survival rates (78-90%) are obviously conditioned by tumor features. Finally, the authors reaffirm, with their personal experience as well, the importance of local excision as curative operation for low rectal early cancer, provided that a careful case selection is made in accordance with macro- and microscopical features of the tumor.