Surgical Management Options Of Rectal Cancer

Abstract

Background: Local recurrence ( LR ) rate of  cancer rectum  is more  than  colon cancer . This is  may be due to  technical difficulties in obtaining clear resection margins and  narrow bony pelvic field. When planning surgical treatment of rectal cancer , the rectum can be generally divided into three regions: lower, middle and upper thirds. The upper rectum is generally defined as extending 11 to 15 cm from the anal verge. Tumors of the proximal rectum, at the level of the sacral promontory, behave similarly to colonic cancers and are therefore generally considered to be "rectosigmoid" cancers. Tumors 6 to 10 cm from the anal verge are defined as middle rectal cancers and tumors from 0 to 5 cm are defined as low rectal cancers. Note that low rectal cancers can be associated with the internal and external sphincters, and  anal canal, or levator muscles, or can be above the pelvic floor. The type and extent of surgery performed on patients who have rectal cancer largely depends on the preoperative tumor stage, the  distance from the anorectal sphincter complex, the use of neoadjuvant therapy, histopathologic features, and the patient’s projected ability to tolerate radical surgery. For tumors of the mid to upper rectum, low anterior resection (LAR) is generally the preferred approach. For lesions of the lower rectum, either APR or LAR may be performed, depending on involvement of the sphincter mechanism. The goal with all surgical approaches is an R0 resection with negative distal and radial margins, which are important determinants of surgical outcome, overall survival, and recurrence-free survival. The ideal extent of a bowel resection is defined by removing the blood supply and the lymphatics at the level of the origin of the primary feeding arterial vessel