Mohammed Mohiuddin, MD

In their article, Drs. Wagman and Minsky provide an excellent overview of the current status of local treatment strategies for early rectal cancer. They have rightly pointed out that while minimal surgery is an attractive option, it must be balanced against the highly curable outcomes of radical surgical resection. Expanded experience with stapling devices has extended the level at which safe and satisfactory anastomoses can be accomplished in the distal rectum. The promise of enhanced preservation of rectal, urinary, and sexual functions makes local treatment strategies an attractive option. The most important aspect of disease management using this approach remains the process of patient selection.

The article by Mendenhall et al represents a comprehensive review of their own experience, as well as other large experiences in the literature, aimed at addressing the controversy of whether neck stage predicts local control after irradiation of head and neck cancer. The authors systematically explore this controversy in the setting of both definitive and postoperative therapy. Based on this review, and our own experience, we conclude that there are no significant data showing a correlation between neck stage and local control at the primary tumor site following irradiation of head and neck carcinoma.