[Anterior rectum resection and abdominoperineal rectum excision: guidelines for decision making]

Carcinomae of the upper third of the rectum are, almost without exception, and without loss of continence, resectable. The diagnosis of an intact sphincter function is significant in the pre-operative phase, when deciding whether to carry out an anterior rectum resection or an abdominoperineal rectum exstirpation. Concerning tumours as from G3 in the middle and distal thirds, a safety margin of at least 5 cm distal must be kept, thus making an anterior resection impossible. Stage IV tumours whose growth has infiltrated neighbouring organs or the pelvic wall are also not suitable for resection. Should anatomical circumstances such as excessive adipositae, very large carcinomae, narrow pelvis and enlargement of the uterus or prostata prevent the safe dissection of the mesorectum a sphincter-retaining operation is also not indicated. Oncologic safety is of the highest priority when considering such cases.