Rectal Cancer: Local Therapy

Surgical treatment for rectal cancer typically involves complete resection of the rectum and mesorectum by performing a low anterior resection (LAR) or abdominoperineal resection (APR). Resection of the locoregional lymph nodes has been shown to lower local recurrence rates. However, these operations can be quite morbid. Complication rates following APR resection are as high as 30–60% leading to sexual dysfunction, perineal wound infection and stoma complications. Mortality rates can be as high as 7% following radical resection. APR is reserved for those patients with low rectal cancers involving or adjacent to the anal sphincter that cannot be resected with negative margins without removing the sphincter. However, many patients are opposed to living with a stoma. Local excision avoids the morbidity and mortality of radical resection. Additionally, it may be a better option for those patients deemed high risk for cardiovascular complication following radical resection. Patient selection with proper staging followed by meticulous surgical technique is the cornerstone of oncologic success when contemplating local excision as the definitive treatment for any rectal cancer.