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Updated: Jun 17, 2026

The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors

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Sphincter-sparing resection for rectal cancer.

Kirk A Ludwig¹

¹Duke University Medical Center, Durham, NC 27710, USA. ludwi002@mc.duke.edu

Clinics in Colon and Rectal Surgery

|December 17, 2009

Summary

This summary is machine-generated.

Sphincter-preserving resection is now the standard for rectal cancer treatment. Advanced techniques allow for successful preservation in most cases, even for low-lying tumors, restoring gastrointestinal continuity.

Keywords:

Sphincter-preserving resection coloanal anastomosis intersphincteric resection low anterior resection total mesorectal excision

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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

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Published on: February 12, 2022

Area of Science:

Colorectal Surgery
Surgical Oncology
Gastrointestinal Oncology

Background:

Abdominoperineal resection has historically been used for rectal cancer.
Sphincter preservation is increasingly becoming the standard of care.

Purpose of the Study:

To highlight the advancements in sphincter-preserving rectal cancer surgery.
To emphasize the oncologic principles guiding modern rectal cancer resection.

Main Methods:

Neoadjuvant chemoradiation therapy
Total mesorectal excision (TME)
Intersphincteric proctectomy with colonic J-pouch to anal anastomosis

Main Results:

Sphincter preservation is achievable in most patients, even with low rectal tumors.
Focusing on the deep, circumferential, or lateral margin is crucial for oncologic outcomes.
Gastrointestinal continuity can be restored after tumor resection without external sphincter involvement.

Conclusions:

Sphincter-preserving resection is the current state-of-the-art for rectal cancer.
Oncologic safety is maintained by ensuring adequate margins, not necessarily by removing the sphincter.
Modern surgical techniques and multimodal therapy enable successful sphincter preservation and functional restoration.