A number of contributions dealt with the use of adjuvant therapy (radiation, chemotherapy, or both) for rectal carcinoma, treated eventually by radical extirpation. This report presents a 30-year series of patients who underwent local excisional therapy for small lesions (T1 and T2 adenocarcinomas). Paty PB, Nash GM, Baron P, et al. Long-Term Results of Local Excision for Rectal CancerAnn Surg. 2002;236:522-530. Local excision for rectal cancer is appealing for its low morbidity and excellent functional results. However, it has definite limitations related to the uncertainty of oncologic outcome. The authors, from Memorial Sloan-Kettering Cancer Center, reviewed medical records of 125 patients with T1 and T2 rectal lesions undergoing local excisional therapy supplemented with radiation therapy in 31 cases. Median follow-up was almost 7 years. Ten-year local recurrence and survival rates were 17% and 74%, respectively, for T1 lesions and 26% and 72%, respectively, for T2 lesions. Median time to local recurrence was 1.4 years; for distant recurrence, 2.5 years. Intratumoral vascular invasion was the only predictor of survival. Some patients with local recurrence were treated by means of more radical resection. Thus, the long-term risk of local excision of T1 and T2 rectal cancers is substantial. Perhaps better current preoperative therapies are available in this more modern era to alleviate part of this problem.