Extent of surgical therapy for rectal cancer. Standards and perspectives

摘要

The spectrum of modern surgery for rectal cancer covers a range of different operations which should be differentially used following careful patient selection. Optimal surgery implies that a maximum level of oncological therapy is achieved without unnecessary morbidity, functional impairment or loss of quality of life. As a consequence "low risk" cancers should be treated by local excision to avoid undue morbidity even if a minimal risk of local recurrence must be accepted. Furthermore, sphincter preservation is possible if cancers are situated more than 1-2 cm above the dentate line in patients with normal continence so that an abdomino-perineal excision is only mandatory for tumors below this level. Most patients are operated on by anterior rectal resection and total mesorectal excision. It is currently under investigation whether partial mesorectal excision is sufficient for tumors in the upper third of the rectum. Optimal radical surgery for rectal cancer may also mean that multivisceral excision is necessary to achieve the R0 situation which represents a prerequisite for a possible long-term disease-free survival.