Approximately 34 per cent of colorectal cancers are located in the rectum. Rectal cancer surgery is accompanied with high morbidity an lon-term poor functional outcome. Screening programs have shown to result in a shift towars more early staged cancers.

Patients with early rectal cancer can potentially benefit significantly from rectal preserving therapy resulting in significantly less morbidity and better function and quality of life compared to radical surgery. For the earliest stage cancers, local excision is sufficient when the risk of lymph node disease and subsequent recurrence is <5%. However, the majority of early cancers are associated with an intermediate risk of lymph node involvement (5-20%) suggesting that local excision alone is not sufficient.

However, completion radical surgery, which is currently standard of care, could be a substantial overtreatment for this group of patients. The aim of this study is to determine the oncological safety, treatment related morbidity, and the functional outcome of rectal preserving therapy for early rectal cancer; local excision followed by adjuvant chemo-radiotherapy is compared to local excision followed by completion radical resection of intermediate risk early rectal cancer.