Current problems in the surgical management of rectal cancer

Three issues associated with surgical treatment of rectal cancer are discussed in the present study. Necessity of standardisation of preoperative irradiation, based on interdisciplinary consensus is considered. The most urgent task is increasing the proportion of sphincter saving resections carried out by total mesorectal excision as related to the number of rectal exstirpations. The principles of surgical therapy of hepatic metastases of colorectal cancers are discussed.

The experience gathered from 328 radical resections performed during the years 1999-2002 is summed up.

Three periods are compared; they managed to raise the proportion of surgical interventions preserving the rectal sphincter over 60%, during the last period the results have even further been improved. Total mesorectal excision performed by an atraumatic technique has been introduced and applied in their department. The rate of morbidity--28.8, 18.6 nd 5.3% for suture insufficiency--has been reduced. During the last eight years segment oriented liver resection indicated by the presence of hepatic metastasis has been performed in 20 instances.

In addition to preoperative irradiation considered as necessary, the authors recommend treatment consisting of 5 x 5 Gy for early cancer, and of 60 Gy/6 weeks for advanced stages. In their opinion, application of atraumatic surgical techniques and up-to-date circular sewing machines can increase the proportion of sphincter preserving interventions securing the patient a better quality of life without abandoning the priciples of radicality. In their hope, the use of total mesorectal excision carried out adequately may reduce morbidity (suture insufficiency and nerve lesions--impaired innervation and sexual dysfunction) and the rate of local relapses and may improve survival. The only curative treatment of hepatic metastases of colorectal cancers is resection; therefore the authors raise the possibility of enlarging the range of surgical indications - more than three metastases in one lobe, bilateral affection.