Local therapy for rectal cancer

In selected patients with early rectal cancer, local therapy is an effectiv e alternative to radical resection and offers minimal morbidity and the avo idance of a colostomy. Several techniques are described: transanal excision , dorsal approaches (York-Mason or Kraske procedures), transanal endoscopic microsurgery, endocavitary radiation, and transanal fulguration. Among the se, transanal excision is favored for the low rate of complications, promis ing outcomes, and ability to secure tissue for pathology. Patients with TI lesions with favorable histologic features may undergo local excision alone , while those with T2 lesions require adjuvant chemoradiation. The data cur rently available do not support the use of local therapy with curative inte nt for tumors that are advanced (T3 or T4), poorly differentiated, or have other negative pathologic characteristics. In carefully selected patients f or local excision, local recurrence and survival rates are similar to tradi tional radical resection. Following local excision, patients require close observation for recurrence. Most patients with local recurrence can be salv aged by radical resection, though the longterm outcome is unknown. (C) 2001 Published by Elsevier Science Ltd.