A 55-year-old man with a T1 N0 rectal adenocarcinoma 4 cm from the anal verge, well-differentiated, no lymphovascular invasion on MRI, undergoes transanal local excision. Histology shows clear margins (R0). What is the recommended next step?

• A Adjuvant chemoradiotherapy regardless of pathology
• B Radical resection (anterior resection) due to proximity to anal verge
• C Adjuvant radiotherapy to reduce local recurrence
• D Surveillance alone — local excision is curative for T1 lesions ✓

Explanation

For T1 low-risk rectal cancer (well-differentiated, no lymphovascular invasion, superficial submucosal invasion — sm1/sm2, R0 resection), local excision alone achieves equivalent outcomes to radical surgery, with local recurrence rates <5% and preservation of sphincter function. Radical surgery is reserved for T1 high-risk (sm3, poorly differentiated, LVI) or T2+ disease. This patient's profile meets all low-risk criteria.

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

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Written and medically reviewed by the StethoPrep medical team.