Surgical treatment options for rectal cancer

Precise staging of rectal carcinomas is mandatory in order to improve the long-term results and to individualize therapeutic approach. Endorectal ultrasound is important in accurately staging the tumor by identifying both depth of invasion and presumptive nodal status. Conventional local excision (LE) of a properly selected group of patients with low risk rectal cancers can provide long-term survival, with minimal morbidity, negligible mortality and excellent functional results. Under a curative intention, local excision of distal rectal tumors (located 4 to 18 cm from the anal verge) can be performed by transanal endoscopic microsurgery (TEM). In the future (neo-) adjuvant therapies can further improve results of these procedures.