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Local Excision of Rectal Cancer

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Modern Management of Cancer of the Rectum

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Abstract

Transanal Local Excision has become a very useful surgical tool for the management of selected cases of rectal cancer due to its low postoperative morbidity and minimal functional consequences. However, the considerably high local recurrence rates led to the introduction of preoperative therapies. Neoadjuvant chemoradiation therapy has been considered the preferred alternative in this setting and may result in significant rates of tumor regression allowing the procedure to be offered to a significant proportion of cases. On the other hand, this multimodality approach may also determine increased postoperative morbidity. In addition, completion or salvage total mesorectal excision in the case of local recurrence or the presence of unfavorable pathological features may also be a challenging task. Finally, accurate selection criteria for this minimally invasive approach are still lacking and may be influenced by baseline staging, post-treatment staging and final pathology information. Ultimately, selection of patients for this treatment modality remains a significant challenge for colorectal surgeons. In the present chapter, the rationale, surgical technique and outcomes of transanal local excision are detailed both after surgery alone or in the setting of multimodality therapy.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Angelita & Joaquim Institute, University of São Paulo School of Medicine, São Paulo, 04001-005, Brazil

    Angelita Habr-Gama MD, PhD & Marleny Novaes Figueiredo MD

  2. Department of Colorectal Surgery, Angelita & Joaquim Gama Institute, São Paulo, 04001-005, Brazil

    Laura Melina Fernandez MD, Guilherme Pagin São Julião MD & Rodrigo Oliva Perez MD, PhD

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  1. Angelita Habr-Gama MD, PhD
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  2. Marleny Novaes Figueiredo MD
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  3. Laura Melina Fernandez MD
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  4. Guilherme Pagin São Julião MD
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  5. Rodrigo Oliva Perez MD, PhD
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Correspondence to Angelita Habr-Gama MD, PhD .

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Editors and Affiliations

  1. Colon and Rectal Surgery, Yale School of Medicine, New Haven, Connecticut, USA

    Walter E. Longo

  2. Colon and Rectal Surgery, Yale School of Medicine, New Haven, Connecticut, USA

    Vikram Reddy

  3. University of Liverpool St Helens Teaching Hospital, St Helens, United Kingdom

    Riccardo A. Audisio

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Habr-Gama, A., Figueiredo, M.N., Fernandez, L.M., São Julião, G.P., Perez, R.O. (2015). Local Excision of Rectal Cancer. In: Longo, W., Reddy, V., Audisio, R. (eds) Modern Management of Cancer of the Rectum. Springer, London. https://doi.org/10.1007/978-1-4471-6609-2_9

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