Sphincter-Saving Resection for All Rectal Carcinomas

Abstract

The technique of intersphincteric resection permits us to achieve conservative surgery in patients with a tumor close to or in the anal canal without compromising local control and survival. Tumor distance from the anal verge is no longer a limit for sphincter-saving resection.

Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

“…Unexpected These are universally accepted oncological statements and are common sense for both open and laparoscopic surgery [72][73][74]. T4 tumours have been excluded from all randomised studies in laparoscopic colon and rectal cancer surgery.…”

“…Using the anal Scott spreading device (lone star) the anus and distal rectum are exposed, and the rectum transected proximal to the dentate line after intersphincteric dissection. The specimen can be retrieved through a small Pfannenstiel incision or through the anus, and an end-to-side or J pouch anastomosis is performed [74,85,106,107]. The presacral space should be drained and a defunctioning loop ileostomy created to protect the anastomosis [91,92].…”

Colonic Reservoirs in Patients After Rectal Resection

“…The distal 2 cm margin of the intestinal wall may be smaller if intraoperative microscopic examination rules out malignant infiltration within the resection line (5)(6)(7)(8)(9). In cases of cancer at low location, it is only allowable to resect the rectum along with part of the anus (particularly including the internal anal sphincter, but also with inclusion of the entire internal and part of the external anal sphincter), if this guarantees appropriate quality of the resection margin and preserves the efficiency of the sphincter apparatus to control defecation (10,11,12). Preservation of a rectal stump favours better bowel and gas continence (13).…”

“…New methods of oncological treatment and rehabilitation, utilization of increasingly sophisticated staplers for surgical procedures and the achievements of videosurgery, all promise further improvement of the quality of life of patients undergoing rectal resection in which the anus was spared and a fecal reservoir formed (7,11,61,62,63).…”

Treatment for cancer of the lower rectal ampulla. State-of-the-art

“…В 2000-х годах началась дискуссия о возможности дальнейшего уменьшения дистального края резек-ции до 1 см, что позволяло даже при низкой локализации опухо-ли выполнять сфинктеросохраняющие операции без ухудшения онкологических результатов [15,16].…”