A 62-year-old man presents with rectal bleeding and colonoscopy reveals a polypoid lesion at 6 cm from the anal verge. Biopsy shows T1 rectal adenocarcinoma. MRI pelvis confirms invasion confined to submucosa (sm1), negative circumferential resection margin (CRM) of 3 mm, no lymphovascular invasion, and well-differentiated histology. The preferred treatment is:

• A Transanal endoscopic microsurgery (TEM) / TAMIS local excision ✓
• B Abdominoperineal resection (APR)
• C Neoadjuvant chemoradiation followed by low anterior resection
• D Short-course radiotherapy followed by radical resection

Explanation

T1 rectal cancer with favorable histological features (sm1 depth, well-differentiated, no LVI, clear CRM) is ideally treated by organ-preserving transanal excision — either TEM (transanal endoscopic microsurgery) or TAMIS (transanal minimally invasive surgery). These approaches achieve local excision with full-thickness margins and comparable oncological outcomes to radical resection for carefully selected T1 lesions. APR and LAR are radical operations not required for early T1 cancer with favorable pathology; neoadjuvant CRT is used for locally advanced disease.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.