Sphincter preserving techniques in rectal cancer and their limitations

Area of Science:

• Colorectal Surgery
• Surgical Oncology

Background:

• Tumors in the anal canal or within 5 cm of the anal verge necessitate specific surgical interventions.
• Traditional techniques like Turnbull-Cutait pull-through and abdominotransanal resection have been employed.
• Advancements include low anterior resections using stapling instruments and neo-rectal reconstructions.

Purpose of the Study:

• To review surgical options for rectal cancers, particularly those located low in the rectum or anal canal.
• To discuss the evolution and current relevance of various surgical techniques.

Main Methods:

• Review of established and emerging surgical procedures for rectal cancer.
• Discussion of techniques including abdominoperineal resection, Turnbull-Cutait, abdominotransanal resection, and low anterior resection.
• Mention of ongoing trials evaluating J-configured neo-rectums.

Main Results:

• Abdominoperineal resection with permanent colostomy is the sole option for tumors in the anal canal or very low rectal margins.
• Low anterior resections with stapling instruments have seen a resurgence in interest.
• Ongoing research explores neo-rectal construction to improve outcomes.

Conclusions:

• Abdominoperineal resection with colostomy remains a crucial and effective treatment for ultralow or low rectal cancers.
• Despite advancements, established techniques are still relevant for specific patient populations and tumor sites.
• Surgical approaches continue to evolve, with a focus on improving functional outcomes.