Early Rectal Cancer: Advances in Diagnosis and Management Strategies

Colorectal cancer (CRC) is the second most prevalent cause of cancer-related death and the third most common cancer globally. Early-stage rectal cancer is defined by lesions confined to the bowel wall, without extension beyond the submucosa in T1 or the muscularis propria in T2, with no indication of lymph node involvement or distant metastasis. The gold standard management of rectal cancer is total mesorectal excision (TME) however, it is linked to considerable risks, including genitourinary dysfunction, faecal incontinence, permanent stoma, and impaired quality of life. There is a rising interest in local resection and non-operative treatment of early RC for organ preservation. Local resection options include two types of transanal endoscopic surgery (TES); transanal endoscopic microsurgery (TEM), Transanal endoscopic operations (TEO) and transanal minimally invasive surgery (TAMIS), while the endoscopic resection includes endoscopic mucosal resection (EMR), underwater (UEMR) and endoscopic submucosal dissection (ESD). Although the oncological outcome of local resection of early rectal cancer is debatable in the current literature, there are some studies that showed comparable outcomes with radical surgery in selected patients. Use of adjuvant and neoadjuvant chemoradiotherapy in early rectal cancer management is also controversial in the literature, but a number of studies showed promising outcomes. This review focused on discussing variations in staging, diagnostic difficulties, management strategies, and outcomes with possible recommendations.