[Surgical standards in rectal cancer]

At present, a differentiated surgical treatment approach allows a curative resection (R0) for carcinoma of the rectum to be obtained in up to 80% of cases. Through the introduction of organ-preserving therapeutic procedures (polypectomy and transanal full-thickness excision), as well as the consequent extension of sphincter-preserving procedures (deep anterior rectum resection with stapler anastomosis and abdomino-peranal rectum resection with colo-anal anastomosis), the rate of sphincter-preserving operations has been increased to 80-85%. A detailed knowledge of the mode of spread of carcinoma of the rectum forms the basis for all differential diagnostic considerations as well as the operative technique. Observance of an adequate margin of clearance as dependent on tumour stage as well as the performance of an anatomically--and oncologically--correct pelvic dissection are requisites for a radical treatment of carcinoma of the rectum. Only a strict compliance of the indications criteria which have been worked out permit the use of limited therapeutic procedures.