TABLE 1.

Fifty-Seven-Year-Old Man With Preoperative Stage uT1N0 Freely Mobile, Moderately Differentiated Adenocarcinoma. Tumor is 2 cm in Diameter, Involves <25% of Circumference, and is Located 6 cm From Anal Verge. No Lymphovascular Space Invasion is Noted. Clinical Condition: Local Excision in Rectal Cancer

Treatment	Rating	Comments
Local excision, pT1N0, and negative margins
Observation	9
RT alone	2
Chemoradiation	1
Local excision, pT1N0, and positive margins
LAR or APR	9
RT alone	2
Chemoradiation	2
Observation	1

Rating Scale: 1, 2, 3 usually not appropriate; 4, 5, 6 may be appropriate; 7, 8, 9 usually appropriate.

Discussion: patients with uT1N0 rectal cancers with negative margins and no clinical or histological factors associated with risk for local recurrence have excellent LC after LE alone. Risk factors associated with increased risk for local recurrence include tumor size >2.5 cm,³⁹ adverse pathologic features (high-grade tumors and lymphovascular or perineural space invasion), or tumors occupying >40% of the rectum.^14,40–45

APR indicates abdominoperineal resection; LAR, low anterior resection; RT, radiation therapy.