Operative techniques for radical surgery for rectal carcinoma: can surgeons improve outcomes?

Local recurrence rates following resection of rectal cancer with curative intent are extremely variable. An appropriate anatomic dissection of the rectum is essential to accomplish a complete removal of the tumor and has been described since the 1940s. In the last two decades, increased emphasis has been placed on the concept of total mesorectal excision as the fundamental technical step to minimize local recurrence rates. It is currently accepted, however, that complete removal of the mesorectum is not necessary for all rectal cancer cases. On the other hand, measurement of the free radial margins should be routinely performed to evaluate the local aggressiveness of the disease and assess the potential for a curative resection.