[Sphincter-preserving surgery in rectal cancer]

Surgical treatment for rectal cancer in the medium and lower third was traditionally abdominoperineal resection, but the possibility of sphincter preserving procedures has been emphasized in the last decades.

This review article was performed in order to discuss and analyze the surgical procedures available for treatment of rectal cancer.

Surgical treatment of rectal cancer has changed due to a better understanding of the biological behavior of the tumor, improvement in diagnostic tests to stage the disease, and the development of better surgical techniques (surgical staplers) with the consequent increase in the possibility of sphincter-saving procedures. Adjuvant therapy has played a major role for improving the patient's prognosis. Even with all these improvements, the final outcome has not been changed in the last 15 years, and prospective studies are necessary to clarify the polemic issues still in debate: the development of better prognostic factors, more sensitive staging tests, the role of the complete mesorectal excision and pelvic lymphadenectomy, the adequacy of laparoscopic techniques in malignant disease, and the finding of the ideal scheme of adjuvant therapy.

Significant progress has been made in the treatment of rectal cancer, but there are still important issues to be solved.