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Invited Critique
July 1, 2007

Oncological Outcome of Local vs Radical Resection of Low-Risk pT1 Rectal Cancer—Invited Critique

Arch Surg. 2007;142(7):656. doi:10.1001/archsurg.142.7.656

It is a truism that, in the treatment of rectal cancer, the best chance for cure is the first chance. Therefore, the principle is established that the first priority of rectal cancer treatment is complete eradication of the disease. This philosophy somewhat defuses the debate over local vs radical resection because, as the authors point out, local excision is a compromise. In this compromise, nodal excision and wide margins are sacrificed in favor of reducing morbidity and, perhaps, preserving anal defecation. Whether this compromise is reasonable depends on the risk of nodal involvement with cancer, the likelihood of obtaining clear margins with local excision, and the comorbidity of the patient. Recent reports of oncologic outcome of local excision for T1 cancers suggest that the risk of local recurrence can be surprisingly high.13

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