A literature search was conducted including the following databases: MEDLINE (using PubMed) and the Cochrane Library. Publications not written in English were excluded. Titles and abstracts of retrieved studies were reviewed for relevance and eligibility. Results from the most recent meta-analyses were also included in this review. Full texts of all eligible studies were retrieved and evaluated.

Extensive literature review revealed very few trials that actually compared local and radical resection for T₂ rectal tumors. In fact, there is only one prospective trial that compared local excision (transanal endoscopic microsurgery) with radial resection following neoadjuvant chemoradiation for T₂N₀ rectal cancer [10]. There are no trials that compare local excision to “watch and wait” following chemoradiation for T₂ lesions. There are several “database” reviews that compare both local and radical resection, but suffer from the traditional shortcomings associated with database queries [11, 12]. Therefore, decision making for patients with T₂N₀ rectal cancer remains difficult and cannot generally be based on level I data. It must come from review of trials that separately evaluate local excision, radical resection, and observation therapy.

The tables that are compiled below are a result of contemporary literature review in the management of early rectal cancer. Unfortunately, direct comparisons between treatment modalities are rare. The best an informed surgeon can hope for is to review this data and apply it individually to each patient, looking at functional data, oncologic results, stoma and complication rates.

Table 18.1 depicts local recurrence, cancer specific survival, morbidity, and length of follow-up for available techniques. Table 18.2 looks at permanent stoma rates following local excision, radical resection and chemoradiation alone. Table 18.3 looks at response rates, local recurrence and overall survival following “watch and wait” therapy.