[Anterior rectum resection]

Anterior resection is the method of choice for the treatment of rectal cancer situated in the upper or middle third of the rectum. Hand-sewn and stapled anastomosis methods have shown comparable results with regard to the rate of leakage. Standardized preoperative bowel preparation, antibiotic prophylaxis and a careful surgical technique will lead to a postoperative lethality of below 5% and a surgical complication rate below 15%. The main functional problems following anterior resection consist of incontinence and bladder and sexual dysfunction, but these can be partly avoided by careful surgical preparation. There is controversy in the literature concerning the positive effect of a protective ileostomy or colostomy. The major principles are: (1) radical resection of the tumor, with complete removal of the mesorectum, leaving a minimal distal margin of 2 cm, and (2) a meticulous anastomosis technique: tension-free, pulsation blood flow, tight.