Local Excision of Rectal Neoplasia
Although proctectomy is the most oncologically effective treatment of rectal neoplasms, the procedure is associated with substantial morbidity and chance of temporary or permanent stoma. Transanal local excision offers a viable option for effective treatment of benign rectal neoplasms and early-stage rectal cancers. Outcomes following local excision are dependent on the thoughtful selection of patients for the procedure and optimal surgical technique. It is critical to achieve negative circumferential margins of resection and to remove the tumor without fragmentation. Unfortunately, if pelvic recurrence of cancer occurs following local excision, probability of cure with salvage treatment is low. It is possible that adjuvant or neoadjuvant chemoradiotherapy may improve oncologic outcomes.