UNASSIGNED: Low anterior resection or abdominoperineal resection are considered standard treatments for early @entity5 but may be associated with morbidity in selected @entity1 who are candidates for early distal lesions amenable to local excision (LE). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The panel recognizes the importance of accurate staging to identify @entity1 who may be candidates for a LE approach. @entity1 who may be candidates for LE alone include those with small, low-lying T1 @entity5 , without adverse pathologic features. Several surgical approaches can be utilized for LE however none include lymph node evaluation. Adjuvant radiation  chemotherapy may be warranted depending on the risk of nodal metastases. @entity1 with high-risk T1 @entity5 , T2 @entity5 not amenable to radical surgery may also benefit from adjuvant treatment; however, @entity1 with positive margins or T3 lesions should be offered abdominoperineal resection or low anterior resection. Neoadjuvant radiation  chemotherapy followed by LE in higher risk @entity1 results in excellent local control, but it is not clear if this approach reduces recurrence rates over surgery alone.

ACR Appropriateness Criteria   Local Excision in Early Stage Rectal XXXX .

@entity5 :: ('MESH:D009369', 'Disease') :: ['rectal cancer', 'tumors'] @entity1 :: ('9606', 'Species') :: ['patients', 'Patients']
@entity5 :: (MESH:D009369,Disease) :: ['Cancer']
