Early rectal cancer: local excision or radical surgery?
BACKGROUND
Sphincter preservation, disease control, and long-term survival are the main goals in the treatment of rectal cancer. Although transanal local excision is attractive because it is a sphincter sparing procedure, some contradictory data exist in the literature about its ability to locally control disease and provide overall survival comparable with radical procedures, even for patients with early stage tumor.


OBJECTIVE
To compare transanal local excision and radical surgery treatment results based on the appropriate data in literature.


METHODS
We reviewed the literature to identify the current recurrence and survival rates of both techniques as well as the salvage surgery success. A PubMed search of the last 10 years was performed, and a total of 10 nonrandomized studies were identified; only 1 study was prospective, 5 were comparative, and 5 were case reports.


RESULTS
Five-year overall survival rate varied from 69% to 83% in the local excision group versus 82% to 90% for the radical excision group. Local recurrence rates ranged from 9% to 20% for local excision and from 2% to 9% for radical surgery. Systemic recurrence rates ranged from 6% to 21% for local excision and from 2% to 9% for radical surgery.


CONCLUSIONS
Radical surgery is the more definitive cancer treatment; however, it does not eliminate local excision as a reasonable choice for many patients, who will have lesser procedure-related morbidity and will accept an increased risk of tumor recurrence, a prolonged period of postoperative cancer surveillance, and a decreased success rate by salvage surgery.
Chang
Alexandre Jin Bok Audi
AJ
Department of Gastroenterology, Surgical Division, University of São Paulo, School of Medicine, São Paulo, Brazil.
Nahas
Caio Sergio Rizkallah
CS
Araujo
Sergio E Alonso
SE
Nahas
Sergio C
SC
Marques
Carlos F Sparapan
CF
Kiss
Desiderio Roberto
DR
Cecconello
Ivan
I
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011351:Proctoscopy / Q000379:methods*; D011379:Prognosis; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D016019:Survival Analysis