ABSTRACT
Although there is still a place for abdominoperineal resection in the treatment of
rectal cancer, the state of the art is sphincter-preserving resection. Even for the
lowest of rectal cancers, using a combination of neoadjuvant chemo/radiation, total
mesorectal excision, and intersphincteric proctectomy and colonic J-pouch to anal
anastomosis, sphincter preservation can be achieved for most patients. The key concept
in pushing sphincter preservation forward has been the realization that the deep,
circumferential, or lateral margin is all-important. Unless the rectal tumor involves
the external sphincter muscle, there is no oncologic need to remove it, and following
resection of the tumor, gastrointestinal tract continuity can be restored.
KEYWORDS
Sphincter-preserving resection - total mesorectal excision - low anterior resection
- intersphincteric resection - coloanal anastomosis
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Kirk A LudwigM.D.
Section of Colorectal and Gastrointestinal Surgery, Duke University Medical Center
Box 3262, Durham, NC 27710
eMail: ludwi002@mc.duke.edu
