Until now, no randomized trials of LE and TME have been reported. In particular, there is little current comparative data to assess the oncologic outcomes in patients with clinical (c) T1 not treated with neoadjuvant chemoradiotherapy. In accordance with previous studies, the current study reported that the local recurrence rate after LE is higher than that after TME [4]. The authors reported that the 5-year local recurrence-free survival rate was 83.3% in the LE group compared with 98.9% in the TME group (P=0.001). Interestingly, although the local recurrence was high, there was no significant difference in the overall survival rate between LE and TME in patients with pT1. In pT2, however, the cancer-specific survival was worse in the LE group than in the TME group. After experiencing local recurrence in the LE group, the authors suggested that salvage operation could be a good treatment option. They showed that all local recurrence could be treated with salvage surgery, with good prognosis, especially in patients with pT1. In patients with a cT1 tumors appearing pathologically as pT2, approximately 32% experienced tumor recurrence. The authors reported that local recurrence arising from pT2 may also be a good candidate for salvage surgery; 1 patient died due to cancer. Because there were only 22 pT2 patients, a convincing conclusion could not be drawn. The authors showed that besides tumor depth, age and angiolymphatic invasion were independent risk factors for overall survival. This was similar to the findings of a previous study [5].

If preoperative imaging shows no risk factors, LE, which leads to fewer complications and good functional results, could be achieved in a large proportion of patients [6]. If histopathological examination identifies a worse prognosis, adjuvant treatment or salvage surgery should be recommended. Currently, salvage surgery remains the standard of care in high-risk pT1 and pT2 tumors, but the benefit of additional treatment including chemotherapy or chemoradiotherapy remains unclear. In the near future, the role of LE in clinical practice may expand due to the implementation of LE combined with other treatment strategies.