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Clin Colon Rectal Surg 2007; 20(3): 203-212
DOI: 10.1055/s-2007-984864
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Sphincter-Sparing Resection for Rectal Cancer

Kirk A. Ludwig1
  • 1Section of Colorectal and Gastrointestinal Surgery, Duke University Medical Center, Durham, North Carolina
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Publication History

Publication Date:
31 July 2007 (online)

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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

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