[Current status of the therapy of rectal cancer]

Changes have taken place in the methods used for surgery of rectal carcinoma. The primary tumour is removed and the regional lymphatic drainage area left behind, when limited techniques are chosen, that is in cases in which the risk of lymph node metastasis is not significant. Such indication is based on the careful histopathological examination of the locally removed primary tumour. Differential indications are described, with reference being made to excision of the rectum as compared to anterior and deep anterior resection. Palliative tumour resection and surgical removal of hepatic metastasis improve the prognosis. Radical tumour resection requires complete mobilisation of the left colonic flexure, high ligature of the inferior mesenteric artery, and--in cases of extraperitoneal tumours--dissection along the fascias. Tubular resection of the rectum is indicated for early rectal carcinoma as well as in cases of large villous or tubular adenomas. Reference is made to adjuvant chemo- and radiotherapy.