[Differential therapy in rectal carcinoma]

In a consecutive series of 91 patients with carcinoma of the rectum the potentialities, i.e. the pathologic basis and technical details of selective surgical treatment are reviewed. With respect to radical local excision--the only sphincter-saving procedure for low lying tumours--the depth of tumour penetration must be related to pathologic stage. These relationships are reviewed. A local procedure was judged adequate in 11% of patients. The pathologic stage necessitated major operative procedures in 81% of patients, including abdomino-perineal resection in 21%. Low anterior and abdomino-transsphincteric resections contributed more often to sphincter preservation than did local excision. A restorative procedure was possible in 82% of carcinomas localized in the mid-third of the rectum; further improvement may be possible by abdominotransanal stapled anastomosis. A high percentage of (low) anterior resections (80%) did not impair operative mortality (1.2%) in the series.