"If you start tackling anything above a T2 lesion, you’re probably going to be missing lymphatic disease. It’s of relevance because it will form the site of recurrent disease," she said.
For patients with T1 tumors, overall survival is the same, but disease-free survival and local recurrence rates favor standard resection over local excision. "Selection criteria must be much more restrictive when it comes to a T2 lesion," Dr. Nelson said. "I’m pretty reticent to use it in my own practice. I have to really choose the tumor well and choose the patient well to want to do that with some assurance that it’s the right decision."
She pointed to a study published in 2000 comparing patients who underwent either local excision or standard resection for rectal cancer (Dis. Colon Rectum 2000;43:1064-71). Over about 4.5 years of follow-up, local recurrence for patients with T2 lesions was 47% if they had received local excision, compared with 6% for those who had standard resections. Respective overall survival rates were 65% and 81%.
Dr. Paty and Dr. Nelson reported having no financial disclosures.