Sphincter preserving techniques: from anterior resection to coloanal anastomosis

Nowadays surgery offers a complete spectrum of techniques for the treatment of rectal cancers. Progress in preoperative diagnostic techniques, especially in endoluminal ultrasound, and in the knowledge of anorectal physiology allows the surgeon to adopt a very individual strategy for the various tumor types. The situation has changed even for tumors of the middle and distal thirds of the rectum, which formerly were treated predominantly by abdominoperineal exstirpation. These can also be treated by sphincter-preserving techniques, the most ambitious of which is intersphincteric resection with coloanal anastomosis. Our experience shows that this method is not only comparable to the alternatives of conventional anterior resection and extirpation in terms of postoperative morbidity and mortality but also achieves excellent oncological results. Of course, anorectal function is significantly altered by this type of surgery. Still, after an adaptive period of about 6-12 months a very satisfactory functional result is reached. Further functional improvement, especially in the early postoperative period, can possibly be expected from reconstruction with creation of a colon pouch.