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Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference



The last 30 years have witnessed a significant increase in the diagnosis of early-stage rectal cancer and the development of new strategies to reduce the treatment-related morbidity. Currently, there is no consensus on the definition of early rectal cancer (ERC), and the best management of ERC has not been yet defined. The European Association for Endoscopic Surgery in collaboration with the European Society of Coloproctology developed this consensus conference to provide recommendations on ERC diagnosis, staging and treatment based on the available evidence.


A multidisciplinary group of experts selected on their clinical and scientific expertise was invited to critically review the literature and to formulate evidence-based recommendations by the Delphi method. Recommendations were discussed at the plenary session of the 14th World Congress of Endoscopic Surgery, Paris, 26 June 2014, and then posted on the EAES website for open discussion.


Tumour biopsy has a low accuracy. Digital rectal examination plays a key role in the pre-operative work-up. Magnification chromoendoscopy, endoscopic ultrasound and magnetic resonance imaging are complementary staging modalities. Endoscopic submucosal dissection and transanal endoscopic microsurgery are the two established approaches for local excision (LE) of selected ERC. The role of all organ-sparing approaches including neoadjuvant therapies followed by LE should be formally assessed by randomized controlled trials. Rectal resection and total mesorectal excision is indicated in the presence of unfavourable features at the pathological evaluation of the LE specimen. The laparoscopic approach has better short-term outcomes and similar oncologic results when compared with open surgery.


The management of ERC should always be based on a multidisciplinary approach, aiming to increase the rate of organ-preserving procedures without jeopardizing survival.

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Drs. Mario Morino, Mauro Risio, Simon Bach, Regina Beets-Tan, Krzysztof Bujko, Yves Panis, Bjorn Rembacken, Eric Rullier, Yutaka Saito, Tonia Young-Fadok and Marco Ettore Allaix have no conflicts of interest or financial ties to disclose. Dr. Philip Quirke is funded by Yorkshire Cancer Research.

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Morino, M., Risio, M., Bach, S. et al. Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference. Surg Endosc 29, 755–773 (2015).

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  • Early rectal cancer
  • Local excision
  • Neoadjuvant chemoradiation
  • Laparoscopy
  • Total mesorectal excision