Abstract
Local excision (LE) of properly selected rectal cancers can provide longβterm survival, with minimal morbidity, negligible mortality, and excellent functional results. The role of LE has evolved over the past century. Initially, to avoid the excessive mortality of abdominal surgery, aggressive LE was performed to control the symptoms of rectal cancer. As abdominal surgery became safer, LE was restricted for use in palliation or highβrisk patients. Better preoperative tumor staging resulted in an expanded role for LE, including curativeβintent treatment of selected T~1β2~ rectal cancers. Techniques for LE include snare polypectomy, transanal excision, transanal endoscopic microsurgery, and posterior approaches. The high local recurrence rate and compromised survival reported in modern series, despite efforts to properly select patients with cancers suitable for LE, have convinced the authors to restrict the use of curativeβintent LE in goodβrisk patients only to the most favorable rectal cancers. Close followβup after LE is critical, because radical surgical salvage is usually possible if recurrence is identified promptly. Whether adjuvant chemoradiation can expand the role of curative intent LE remains controversial. Semin. Surg. Oncol. 19:367β375, 2000. Β© 2000 WileyβLiss, Inc.