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Background <p>Despite a&#xa0;decline in advanced colorectal cancer due to screening programs, the number of major surgical colorectal resections for benign findings and early rectal cancer remains high. Endoscopically nonresectable adenomas frequently lead to unnecessarily extensive surgery with significant morbidity. Organ-preserving approaches are gaining importance, with surgery playing a&#xa0;key role.</p> Objective <p>Presentation of the role of surgery in the local excision of early colorectal cancer as part of a&#xa0;differentiated interdisciplinary treatment strategy.</p> Material and methods <p>Systematic review of the current literature on endoscopic, surgical and combined resection techniques in early colorectal cancer, with a&#xa0;focus on specimen quality, oncological safety and organ preservation.</p> Results <p>While endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are curative in selected cases with suitable indications, their effectiveness is limited in large, fibrotic or distal rectal lesions. In such cases, surgical techniques, such as transanal endoscopic microsurgery (TEM), transanal minimally invasive surgery (TAMIS) or transanal endoscopic operation (TEO) enable a precise, layer-specific resection and provide high-quality specimens, essential for a reliable histopathological risk stratification. In the colon combined procedures, such as combined endoscopic-laparoscopic surgery (CELS) provide an oncologically safe, organ-preserving alternative to formal colectomy for technically complicated lesions.</p> Conclusion <p>Surgical local excision is not merely a&#xa0;salvage procedure but a&#xa0;key component of modern, organ-preserving treatment concepts for early colorectal cancer. When performed with precision, it enables both accurate diagnostics and a definitive curative treatment in low-risk constellations. Surgery thus plays an essential role in ensuring functional preservation and oncological safety in early-stage disease.</p>

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Endoskopische Therapie kolorektaler Frühkarzinome – Pro Chirurgie

  • 期刊论文

  • 发表日期：

    2025年7月22日

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  • Jörg Ernst Mathias Baral

摘要

Background

Despite a decline in advanced colorectal cancer due to screening programs, the number of major surgical colorectal resections for benign findings and early rectal cancer remains high. Endoscopically nonresectable adenomas frequently lead to unnecessarily extensive surgery with significant morbidity. Organ-preserving approaches are gaining importance, with surgery playing a key role.

Objective

Presentation of the role of surgery in the local excision of early colorectal cancer as part of a differentiated interdisciplinary treatment strategy.

Material and methods

Systematic review of the current literature on endoscopic, surgical and combined resection techniques in early colorectal cancer, with a focus on specimen quality, oncological safety and organ preservation.

Results

While endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are curative in selected cases with suitable indications, their effectiveness is limited in large, fibrotic or distal rectal lesions. In such cases, surgical techniques, such as transanal endoscopic microsurgery (TEM), transanal minimally invasive surgery (TAMIS) or transanal endoscopic operation (TEO) enable a precise, layer-specific resection and provide high-quality specimens, essential for a reliable histopathological risk stratification. In the colon combined procedures, such as combined endoscopic-laparoscopic surgery (CELS) provide an oncologically safe, organ-preserving alternative to formal colectomy for technically complicated lesions.

Conclusion

Surgical local excision is not merely a salvage procedure but a key component of modern, organ-preserving treatment concepts for early colorectal cancer. When performed with precision, it enables both accurate diagnostics and a definitive curative treatment in low-risk constellations. Surgery thus plays an essential role in ensuring functional preservation and oncological safety in early-stage disease.