[The rectal cancer--between resection and amputation. Surgeon's decalogue]

The surgeon has the opportunity to use a lot of treatment choices taking into account the site, the progression and the aggressiveness of the rectal tumors. If the treatment of anal cancer have been the same over the last years there are a few problems regarding the rectal cancer, especially for the one, which is distal and locally advanced. The therapeutic choice must take into account the following factors: the site of the tumor, the circumferential invasion, the local and distant spread, the complications and loco-regional recurrences, the anatomical shape of the pelvis, the possibility of developing tumor implants on the residual rectum, the equipment of the hospital, the experience of the surgical team, the accuracy of stoma technique, and the previous results in patients survival. In a trial of 381 patients with recto-sigmoidian and anal cancers we performed 171 rectal amputations, 29 Hartmann procedures and 76 laparotomies and colostomies. From the 276 patients with colostomy 172 (62.31%) were followed. The survival rate was: 6-10 months for the patients with laparotomy and colostomy, 16-24 months for those with palliative procedures (55.8%) and 5-17 years for those with radical procedures. From the point of view of the authors the rectal amputation with colostomy it is an alternative between oncological safety and patients comfort. This kind of surgical procedure must be done in specialized centers excepting the emergencies.