TY - CHAP M1 - Book, Section TI - Local Excision for Stage I Rectal Cancer A1 - Lynn, Patricio Bernardo A1 - Widmar, Maria A1 - Garcia-Aguilar, Julio A2 - Morita, Shane Y. A2 - Balch, Charles M. A2 - Klimberg, V. Suzanne A2 - Pawlik, Timothy M. A2 - Posner, Mitchell C. A2 - Tanabe, Kenneth K. PY - 2018 T2 - Textbook of Complex General Surgical Oncology AB - Total mesorectal excision (TME) remains the gold standard in the treatment of patients with early-stage rectal cancer. The reported oncological outcomes of this approach for stage I disease are excellent, with local recurrence (LR) rates of 3%, and 5-year survival as high as 93%.1 But TME is a major operation associated with some mortality and significant morbidity. More than one in three patients develop perioperative complications.2 Anastomotic leak with low rectal anastomosis occurs in approximately 10% of patients, and has been associated with poor oncological outcomes.3,4 Injuries to the hypogastric and pelvic nerves can cause genitourinary dysfunction in up to 40% of patients5; functional disturbances such as tenesmus, bowel urgency, soiling, and fecal incontinence are also common.6 To prevent the consequences of anastomotic leak, many patients are given a temporary diverting loop ileostomy, which is inconvenient and adds to the burden of morbidity.7 In addition, between 20% and 30% of all rectal cancers—and a higher proportion of patients with distal rectal cancers—require an abdominoperineal excision (APE) of the rectum with a permanent colostomy, a procedure that significantly impacts patients’ quality of life.5 SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/07 UR - hemonc.mhmedical.com/content.aspx?aid=1145762422 ER -