Key Concepts

• Local excision of biopsy-proven rectal cancer requires en bloc full-thickness dissection.
• Predictors of lymph node metastases include tumor depth, lymphovascular invasion, poor differentiation, and tumor budding.
• Local recurrence rates for T2 rectal cancers treated with neoadjuvant therapy and local excision appear similar to those of T1 cancers treated with local excision alone.
• Transanal endoscopic surgery techniques including transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS) may improve surgical outcomes as compared to standard transanal excision techniques.