Preservation of the anus in the therapy of distal rectal cancers

Using the gold standard of APR as a measure of cancer control, sphincter-sparing procedures appear to provide similar rates of local control and survival. Specifically, for T1, T2, and T3 lesions, local excision alone, local excision plus adjuvant therapy, and low anterior resection with coloanal anastomoses, respectively, have proven to be acceptable forms of therapy. However, questions remain as to the significance of certain prognostic factors, such as lymphatic invasion with regard to the treatment plan for patients with low rectal cancers. Lastly, quantitative studies addressing the issue of the function of the spared anal sphincters after surgery with or without adjuvant therapy, and how this relates to the patient's quality of life, need to be performed.