Local Excision Versus Total Mesorectal Excision for Clinical Stage I (cT1–cT2) Rectal Cancer

Early rectal cancer (cT1 and cT2) has been increasingly detected due to the wide application of colorectal cancer screening program. Total mesorectal excision (TME) is a gold standard for the treatment of this early stage disease. However, postoperative complications, unfavorable functional outcomes, and risk of permanent stoma following TME are not uncommon. In contrast, local excision (LE) is less invasive and more tolerable to frail patients and those with severe co-morbidities. Simultaneously, both functional and sexual outcomes following LE were not disturbed and the patient could avoid abdominoperineal resection. The drawback of LE is leaving perirectal lymph node yielding unknown actual pathological nodal staging—which partly leads to more recurrence comparing to TME. This article aimed to review the current evidence of TME and LE in early rectal cancer, to critically review the role and consequence of chemoradiation in LE, and to update ongoing trials on this subject.