The gold standard of care for most Stage I rectal cancers is known as a total mesorectal excision. Local excision is considered an alternative management approach only for highly selected patients (stage T1, N0, M0 tumors that are less than 3cm in size, are not high grade/poorly-differentiated/G3, and have no lymphvascular or perineural invasion).
Local Excision On the Rise: “The use of local excision alone for higher-risk stage I rectal cancers is an inferior cancer management approach, but despite this, we are seeing a rise in the use of local excision,” reports karyn B. Stitzenberg, MD, MPH of the University of North Carolina (USA). A US National Cancer Data Base (NCDB) study found a steady increase in the use of local excision from 1989 to 2003 (Ann Surg 2007;245:726-733). This trend continues as evidenced by a recent study by Dr. Stitzenberg published in Journal of Clinical Oncology on 01 December 2013. These data show that guideline-based adoption of local excision for appropriate patients with Stage I rectal cancer is increasing. However, the use of local excision (as opposed to more extensive surgery) is increasing for higher risk cancers that do not meet guideline criteria for its use.
My Take: Local excision is appropriate only if you meet strict criteria for it. Otherwise a more extensive mesorectal excision by a qualified surgeon offers the best results for the vast majority of patients. Local excision reduces the risk of complications, stomas, and can be associated with a better quality of life (as compared to more radical surgery), but should not be used inappropriately: Salvage surgery after local relapse is suboptimal, and recurrences are often more advanced than the original presentation. Local recurrences following local only excisions are on the order of over 25% for T1 lesions, and roughly 25-46% for T2 tumors. I’m Dr. Michael Hunter.
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Reference: J Clin Oncol 2013;31P4273-4275.