[Anatomical basis, technic and results of narrow transanoabdominal continence resection]

Ultrashort resections of the rectum have been recommended for rectal carcinomas extending below eight cm from the dentate line in order to preserve anal continence. Resection of the main lymphatic pathways together with the adjacent lamellae is important for radical removal of all tumor cells. Valves in the rectal lymph vessels allow lymph fluids to drain only in a cranial direction. There are no lymph nodes below the dorsal adjacent lamella. Thus, a distal margin of two cm from the tumor is sufficient to minimize the risk of recurrence. We recommend a trans-ano-abdominal approach for very low rectal carcinomas. During the past years, we have operated on 156 patients with rectal carcinomas and found five-year-survival rates of 50 percent with rectum resections with colostomies, 62 percent with low anterior resections and 69% with ultra-short sphincter-preserving resections.