Local surgical treatment of rectal cancer

Patients with cancer of the lower third of the rectum can avoid both the morbidity of an APR and the need for a permanent colostomy by having the cancer removed by local excision. If the surgeon clinically suspects that a patient has an early cancer, the first step should be local excision of the tumor. The pathological features of the cancer specimen will then indicate the next step in treatment. This can range from no further therapy to proctectomy with or without an anastomosis (Table 2). Patients with a low risk of local failure can be treated by excision alone. Those with a higher risk of local failure should undergo APR or LAR or enter a protocol to determine the role of local excision and adjuvant chemoradiation.