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Fundamentals of Rectal Cancer SurgeryFundamentals of Rectal Cancer Surgery

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Local Excision

Local Excision is a topic covered in the Fundamentals of Rectal Cancer Surgery.

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In 1908, Miles described the procedure of abdominoperineal resection that became the gold standard for treatment of distal rectal cancer.[1] Success of radical surgery in the form of abdominoperineal or low anterior resection has stood the test of time due to its sound oncologic principles. However, radical resection is not without its disadvantages, including high perioperative morbidity, potential for permanent colostomy, and negative effects on bowel, sexual, and urinary function.[2],[3] Therefore, the role of local excision in the treatment of early rectal cancer has been investigated. This approach involves full thickness excision of the rectal cancer with negative radial and deep margins without inclusion of its mesorectal envelope in the pathologic specimen. Local excision provides faster postoperative recovery with low procedural morbidity and mortality.[4] However, local excision is only appropriate in selected early-stage rectal cancer cases, because recurrence rates are unacceptably high when it is used to treat more advanced tumors.[5],[6],[7],[8],[9]

High local recurrence rates following local excision of rectal cancer result from the omission of nodal staging and clearance of the lymphatic bed along with the tumor. Even T1 rectal cancers have approximately 10% risk of harboring metastatic disease in the lymph nodes.[10] With the advent of newer and more sophisticated local excision techniques that allow improved visualization and precise margins, local excision is commonly practiced for the management of early rectal cancer. A 2013 study based on the National Cancer Database reported that 46.5% of T1 rectal cancers were treated with local excision.[11] The study also showed that patients with T2 tumors treated with local excision had worse survival than those treated with proctectomy or multimodality therapy.

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In 1908, Miles described the procedure of abdominoperineal resection that became the gold standard for treatment of distal rectal cancer.[1] Success of radical surgery in the form of abdominoperineal or low anterior resection has stood the test of time due to its sound oncologic principles. However, radical resection is not without its disadvantages, including high perioperative morbidity, potential for permanent colostomy, and negative effects on bowel, sexual, and urinary function.[2],[3] Therefore, the role of local excision in the treatment of early rectal cancer has been investigated. This approach involves full thickness excision of the rectal cancer with negative radial and deep margins without inclusion of its mesorectal envelope in the pathologic specimen. Local excision provides faster postoperative recovery with low procedural morbidity and mortality.[4] However, local excision is only appropriate in selected early-stage rectal cancer cases, because recurrence rates are unacceptably high when it is used to treat more advanced tumors.[5],[6],[7],[8],[9]

High local recurrence rates following local excision of rectal cancer result from the omission of nodal staging and clearance of the lymphatic bed along with the tumor. Even T1 rectal cancers have approximately 10% risk of harboring metastatic disease in the lymph nodes.[10] With the advent of newer and more sophisticated local excision techniques that allow improved visualization and precise margins, local excision is commonly practiced for the management of early rectal cancer. A 2013 study based on the National Cancer Database reported that 46.5% of T1 rectal cancers were treated with local excision.[11] The study also showed that patients with T2 tumors treated with local excision had worse survival than those treated with proctectomy or multimodality therapy.

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Last updated: November 22, 2021

Citation

"Local Excision." Fundamentals of Rectal Cancer Surgery, 2021. ASCRS U, www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831007/all/Local Excision.
Local Excision. Fundamentals of Rectal Cancer Surgery. 2021. https://www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831007/all/Local Excision. Accessed March 21, 2023.
Local Excision. (2021). In Fundamentals of Rectal Cancer Surgery https://www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831007/all/Local Excision
Local Excision [Internet]. In: Fundamentals of Rectal Cancer Surgery. ; 2021. [cited 2023 March 21]. Available from: https://www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831007/all/Local Excision.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Local Excision ID - 2831007 Y1 - 2021/11/22/ BT - Fundamentals of Rectal Cancer Surgery UR - https://www.ascrsu.com/ascrs/view/Fundamentals-of-Rectal-Cancer-Surgery/2831007/all/Local Excision DB - ASCRS U DP - Unbound Medicine ER -
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Grapherence® [↑37]
    • Fundamentals of Rectal Cancer Surgery
    • Background
    • Rectal Anatomy
    • Rectal Cancer Biology and Hereditary Cancer Syndromes
    • Rationale for Multi-Modality Therapy
    • Preoperative Issues
    • Preoperative Staging
    • Role of Tumor Board
    • Indications for Preoperative Neoadjuvant Therapy
    • Local Excision
    • Indications for LAR Versus Intersphincteric Resection Versus APR
    • Indications for Extended Resection
    • Preoperative Preparation
    • Interoperative
    • Patient Positioning and Equipment for Rectal Cancer Surgery
    • Inferior Mesenteric Artery
    • Inferior Mesenteric Vein (IMV)
    • Splenic Flexure Mobilization
    • Surgical Techniques for Length
    • Technique of Total Mesorectal Excision (TME)
    • Tailored Mesorectal Excision (TME)
    • Bowel Transection and Anastomosis
    • Indications for Fecal Diversion
    • Abdominoperineal Resection
    • Standardized Operative Report
    • Management of Intraoperative Vascular and Urinary Complications
    • Postoperative Issues
    • Rectal Cancer Pathology Assessment
    • Adjuvant Therapy for Rectal Adenocarcinoma
    • Surveillance After Rectal Cancer Treatment
    • Management of Local Recurrences
    • Short-Term Complications - Anastomotic
    • Short-Term Complications - Urinary
    • Ostomy Complications and Management
    • Long-Term Complications – Bowel Dysfunction
    • Long-Term Complications - Sexual Dysfunction and Its Management
    • Parastomal and Perineal Hernias
    • Impact of Postoperative Complications On Oncologic Outcomes
    • Course Complete
    • Final Assessment
Grapherence® [↑37]
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  • Rectal Cancer: Local Excision
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