Lower early-stage rectal cancer surgical approaches: therapeutic options and cancer biomarker alterations.

[BACKGROUND] Low early-stage rectal cancer (LeREC), typically referring to pTis and pT1 tumors without nodal involvement or lymphovascular/perineural invasion and confined to the mucosa, can potentially be treated with transanal local excision techniques. While transanal endoscopic microsurgery (TEM) remains a common minimally invasive option, it is technically demanding and costly. There remains a need for safer, simpler, and more accessible alternatives.

[OBJECTIVE] To evaluate the safety and efficacy of a simplified transanal excision (sTE) combined with the Ruiyun procedure for hemorrhoids (RPH) compared to conventional TEM in the treatment of LeREC.

[METHODS] In this randomized, controlled study, 48 patients with LeREC located within 12 cm of the anal verge were assigned to receive either TEM ( = 20) or sTE combined with RPH ( = 28). Surgical outcomes and postoperative complications were compared. Immunohistochemical analyses of CDK2, CDK4, CDK6, FOXD1, and PAK4 were performed on primary tumor tissues to investigate potential biomarkers associated with tumor recurrence.

[RESULTS] All patients were followed up for 12 months. The sTE + RPH group showed reduced intraoperative bleeding, lower surgical costs, and fewer complications compared to the TEM group. Expression levels of CDK2/4/6, FOXD1, and PAK4 were observed to vary between groups and were potentially associated with recurrence risk.

[CONCLUSION] The combination of sTE and RPH may offer a safe, cost-effective, and feasible alternative to TEM for treating LeREC, particularly in resource-limited settings. It facilitates wider clinical application without compromising curative efficacy.