Organ Preservation and Palliative Options for Rectal Cancer: Chapter in Atallah S. (eds): TAMIS and TaTME

Local excision is a well-accepted organ preserving method for early rectal cancer with substantial lower morbidity and impact on quality of life compared to radical surgery. However, only rectal cancers staged as a T1 tumor limited to the superficial third of the submucosa (sm1) and less than 3 cm in diameter without signs of poor differentiation, lymphatic or vascular invasion, budding, or clustering in the final pathology are oncologically safely treated with radical local excision. These tumors have local recurrence rates of less than 5%. Small locally excised lesions with more risk factors as budding, poor differentiation, and lymphovascular invasion or even T2 lesions have been associated with relatively high recurrence rates. Due to the increased recurrence rate, most guidelines recommend completion radical surgery after local excision of high-risk lesions.