Local excision of rectal cancer

Abstract

Transanal Local Excision has become a very useful surgical tool for the management of selected cases of rectal cancer due to its low postoperative morbidity and minimal functional consequences. However, the considerably high local recurrence rates led to the introduction of preoperative therapies. Neoadjuvant chemoradiation therapy has been considered the preferred alternative in this setting and may result in significant rates of tumor regression allowing the procedure to be offered to a significant proportion of cases. On the other hand, this multimodality approach may also determine increased postoperative morbidity. In addition, completion or salvage total mesorectal excision in the case of local recurrence or the presence of unfavorable pathological features may also be a challenging task. Finally, accurate selection criteria for this minimally invasive approach are still lacking and may be influenced by baseline staging, post-treatment staging and final pathology information. Ultimately, selection of patients for this treatment modality remains a significant challenge for colorectal surgeons. In the present chapter, the rationale, surgical technique and outcomes of transanal local excision are detailed both after surgery alone or in the setting of multimodality therapy.