Conservative management of rectal cancer with local excision and adjuvant therapy

The standard surgical treatment of distal, resectable, invasive rectal canc ers is an abdominoperineal resection or a low anterior resection. Given the morbidity associated with these standard treatments and the frequent need for postoperative therapy, the use of a more conservative approach, such as local excision with adjuvant therapy as primary therapy for selected cases of rectal cancer is appealing. Data from single-institution series as well as recent data from prospective, multi-institutional studies, suggest that local excision with adjuvant therapy is a reasonable alternative to radica l surgery in selected patients. Local excision alone if acceptable treatmen t only for T1 tumors without adverse pathologic features, while local excis ion with adjuvant therapy is an alternative treatment for T1 tumors with ad verse pathologic features and T2 tumors. Some series suggest peroperative t herapy with local excision may be a possible treatment for selected T3 tumo rs; however, the high local failure rates seen in T3 tumors treated with lo cal excision and postoperative therapy cautions against this approach. Func tional results with local excision are generally good, and postoperative mo rbidity and mortality is acceptable. In summary, the results of local excis ion and radiation therapy are encouraging. Randomized trials are needed to determine whether this approach has local control and survival rates compar able to those of radical surgery.