Local excision (LE) with or without chemoradiothera-py represents an alternative treatment to major radical surgery in small low rectal cancer. LE can be used in selected cases with the advantages of lower morbidity and mortality, maintaining at the same time a good functional result. On the other hand, from the literature some concern emerges on the higher rate of recurrence and the possible compromise of the potentials of cure a radical rectal resection would offer. The key to a successful LE is certainly a reliable pre-opera-tive staging and the correct selection of patients. The criteria of eligibility for curative LE are still a matter of discussion and are not generally accepted. In this chapter more useful pre-operative staging tools are analysed in detail, some therapeutic strategies are presented and finally, as to date no guideline has been fully agreed upon, current recommendations for curative and palliative LE are discussed.

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