Local excision in CA rectum is done in all except
"Local excision does not allow complete removal of lymph nodes in the mesorectum, so operative staging is limited. In addition, definitive treatment nt of early-stage rectal cancers by local excision has been shown to be associated with a three fold to five fold higher recurrence rate compared with similar stage cancers treated by radical surgical resection before guidelines for specific selection criteria. Oveime, the selection criteria have been refined to select only patients for this procedure who will have acceptable long-term outcomes. The operation is indicated for mobile tumours smaller than 3 cm in diameter that involve less than 30% of the rectal wall circumference and that are located in the distal rectum. These tumors should be stage T1 (limited to the submucosa), be well or moderately differentiated histologically, and have no vascular Lymphatic invasion. There should be no evidence of Nodal disease on pre-operative ultrasound or MRI. Adherence to these principles results in acceptable local recurrence rates compared with treatment by abdominal perineal resection Carcinoma Rectum amenable to local excision for curative intent Physical features Endorectal ultrasound Tumor <3 cm in diameter Tumor <30% of bowel circumference Tumor located in distal rectum Tumor freely mobile on digital rectal examination T1, T2 lesions No regional LN involvement Ref: Sabiston 20th edition Pgno : 1379
Within 6 cm of anal verge
Lesion <4 cm
Involvement of <40% circumference
T1 and T2 cancer with or without lymph node involvement
G.I.T