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Local excision LE has arisen as an alternative to total mesorectal excision for the treatment of early rectal cancer. Despite a decreased morbidity, there are still concerns about LE outcomes.. Furthermore, patients receiving LE were significantly more prone develop local recurrence RR: 3. Analysis of available transanal surgical platforms was performed, finding no significant differences among them but reduced local recurrence compared to traditional transanal LE OR Finally, we found poor survival outcomes for patients undergoing salvage surgery, favoring completion treatment chemoradiotherapy or surgery when high-risk histology is present..
In conclusion, LE could be considered adequate provided a full-thickness specimen can be achieved that the patient is informed about risk for potential requirement of completion treatment. Early-rectal cancer cases should be discussed in a multidisciplinary team, and patient's preferences must be considered in the decision-making process.. Total mesorectal excision TME remains the corner stone of curative therapy in rectal cancer of all stages. This approach removes the primary tumor and draining lymph node basin, allowing accurate pathological staging.
TME also is also fully curative in patients with node negative and early T-stage cancers. Local excision LE of the rectal tumors avoids common major complications associated with radical operations, but the decreased invasiveness comes at the expense of an oncologically incomplete surgery.
Therefore, LE has been reserved for elderly, sicker and frail patients, considered unfit for radical resection procedures. This has led to consider LE as first line curative option for patients with early-rectal cancer, and no anymore as a second-line treatment for frail patients. Nonetheless, LE precludes definitive assessment of nodal involvement. Although main clinical practice guidelines e. Thus, the optimal treatment of early-rectal carcinoma remains debatable. In order to answer those question systematically, we create a nonfactual clinical scenario, consisting on a 52 years-old male, with no medical records and good physical status ECOG 1 point , diagnosed of a 3.
