A 50-year-old woman is diagnosed with a T1 rectal carcinoma 4 cm from the anal verge. It is <3 cm, <30% of rectal circumference, Gl well-differentiated, no vascular/lymphatic invasion on biopsy. What is the MOST appropriate management?
- A Abdominoperineal resection (APR) with permanent colostomy
- B Transanal endoscopic microsurgery (TEM) or TAMIS local excision ✓
- C Low anterior resection with TME
- D Chemoradiotherapy followed by watch-and-wait strategy
Explanation
A T1 rectal carcinoma meeting favourable criteria (sm1/sm2, well-differentiated, no lymphovascular invasion, <3 cm, <30% circumference, mobile) is suitable for transanal local excision using TEM or TAMIS (transanal minimally invasive surgery) with a full-thickness disc of bowel wall. Local excision avoids the morbidity of radical surgery (permanent colostomy, anastomotic leak, sexual dysfunction). For pT1 low-risk lesions, local excision alone achieves equivalent local recurrence rates to radical surgery. If histology shows pT1 high-risk features (sm3, LVI), completion radical surgery is recommended.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.