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World J Gastrointest Surg. Jul 27, 2021; 13(7): 655-667
Published online Jul 27, 2021. doi: 10.4240/wjgs.v13.i7.655
Management of early rectal cancer; current surgical options and future direction
Vijay Chavda, Oliver Siaw, Sanjay Chaudhri, Franscois Runau
Vijay Chavda, Oliver Siaw, Sanjay Chaudhri, Franscois Runau, Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
Author contributions: Chavda V contributed to the conception, literature review, drafting of manuscript and finalization of manuscript; all remaining authors contributed equally to the conception, drafting and final review of the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: No conflict-of-interest concerns were expressed by any of the contributing authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Franscois Runau, FRCS (Gen Surg), PhD, Surgeon, Department of General Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom. franscois_gerald@yahoo.com
Received: February 7, 2021
Peer-review started: February 7, 2021
First decision: April 6, 2021
Revised: April 13, 2021
Accepted: June 16, 2021
Article in press: June 16, 2021
Published online: July 27, 2021
Processing time: 165 Days and 10.3 Hours
Abstract

Rectal cancer is the second commonest cause of cancer death within the United Kingdom. Utilization of national screening programmes have resulted in a greater proportion of patients presenting with early-stage disease. The technique of transanal endoscopic microsurgery was first described in 1984 following which further options for local excision have emerged with transanal endoscopic operation and, more recently, transanal minimally invasive surgery. Owing to the risks of local recurrence, the current role of minimally invasive techniques for local excision in the management of rectal cancer is limited to the treatment of pre-invasive disease and low risk early-stage rectal cancer (T1N0M0 disease). The roles of chemotherapy and radiotherapy for the management of early rectal cancer are yet to be fully established. However, results of high-quality research such as the GRECCAR II, TESAR and STAR-TREC randomised control trials may highlight a wider role for local excision surgery in the future, when used in combination with oncological therapies. The aim of our review is to provide an overview in the current management of early rectal cancer, the surgical options available for local excision and the future multimodal direction of early rectal cancer treatment.

Keywords: Early rectal cancer; Transanal endoscopic microsurgery; Transanal endoscopic operation; Transanal minimally invasive surgery

Core Tip: Surgical options for local excision can offer the potential for cure in a carefully selected cohort of patients with early rectal cancer, avoiding the risks of major resectional surgery. Numerous risk factors have been defined which influence the likelihood of success with local excision in early-stage disease. The combined use of oncological therapies, in the form of radiotherapy and chemotherapy, for high-risk early-stage disease may offer a wider role for local excision, which at present is limited by the risk of local recurrence.