[Surgical therapy of rectal cancer]

Abstract

Surgical excision of rectum carcinoma by amputation, resection or locally delimited excision has remained to be the optional curative approach to carcinoma of any position, severity, type and phase. Low-dose heparinisation, oral intestinal washing, and perioperative application of antibiotics have retained their established positions in the run-op to surgical action. The value of perioperative radiotherapy is still unelucidated. Chemotherapy has so far failed to produce a safe adjuvant effect. The age limit to curative intervention is continuously moved upwards. Resection is more often chosen than other approaches. Safely established knowledge is likely to suggest that the atumorous aboral safety zone may be reduced to 2 cm, provided that the perirectal lymphatic channels are severed at equal level. Anastomosis in cases of deeper anterior removal can often be sutured only by staplers. There is a growing number of situations in which the approach can be taken without preceding colostomy. Transanal and transsphincteral access routes are available for locally delimited tumour excision. Postoperative lethality has been continuously lowered and is now below five per cent. Reported in this paper are the authors' own results over the past decade.