Local excision for rectal carcinoma.
Local excision is an alternative approach to radical proctectomy for rectal cancer, but from an oncologic standpoint, it is a compromise, and its role remains controversial. Careful patient selection is essential because local excision is generally considered only for early rectal cancer with no evidence of nodal metastasis, parameters that can be predicted by clinical examination, and various radiologic modalities with variable accuracy. In this review, we present the literature evaluating the oncologic adequacy of local excision, including transanal endoscopic microsurgery and the results of salvage surgery after local excision. An overview of local excision in the context of perioperative adjuvant therapies is included. Finally, we suggest a treatment algorithm for local excision in rectal cancer.
Kim
Edward
E
Department of Surgery, University of California, San Francisco, CA, USA.
Hwang
John M
JM
Garcia-Aguilar
Julio
J
D000465:Algorithms; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D008866:Microsurgery / Q000379:methods; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018579:Patient Selection; D011351:Proctoscopy / Q000379:methods; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016879:Salvage Therapy