[Conservative surgery in rectal cancer]

The Authors analyse their experience about 387 cases operated for rectal cancer. The choice of the operation was not related to tumour's features, but was related to the location of the neoplasia. The safety margin of rectal resection was reduced up to a minimum of 2 cm. in lower tumours, where it was not possible to meet this condition an abdomino-perineal resection was performed. A lumbo-aortic lymphadenectomy with high ligature of inferior mesenteric artery was always performed; in 17 cases it was extended to the pelvic nodes. In all the patients the whole mesorectum was removed and a wide pelvic dissection was performed to avoid the so called cone effect. Since 1991 all the B2-C patients undergo preoperative radiotherapy. Recurrence rate and survival are similar both after abdomino-perineal and sphincter-saving resections. Among the different risk factors, the Authors have found a statistically significant relation only with the stage. The Authors, therefore, conclude that sphincter-saving resection is the best surgical procedure because of the god quality of life. They stress the importance of a lumboarotic lymphadenectomy with high ligature of inferior mesenteric artery. As far as the complementary therapy is concerned, the discussion is still open, especially about the timing and the choice of the adjuvant treatment.