Lateral pelvic lymph node dissection in low rectal cancer

While total mesorectal excision (TME) and abdominal-perineal resection provide standard of care procedures for major oncologic resection of rectal cancer, the transanal approach to rectal lesions offers solutions to complex problems with the added benefits of other minimally invasive procedures. By utilizing the perianal approach, surgeons can minimize surgical stress and optimize function without compromising oncologic outcome. The potential morbidity associated with radical surgery (including major medical complications, impaired sexual and urinary function, reduced fecal continence, and the need for a permanent stoma) is in large part avoided altogether. Parks described the first transanal submucosal excision of a rectal lesion in 1966, 1 and transanal local excision (TLE) continues to serve as an option for cure in select patients who present with early tumors and favorable characteristics. In addition, it remains a palliative procedure for more advanced disease in high-risk patients. With proper selection of appropriate candidates, TLE stands as a useful and valuable tool in the surgeon’s armamentarium for rectal lesions.