[Sphincter conservation and cancer of the lower rectum: argument for a multicenter prospective study for conservation of the sphincter after irradiation].
Rectal adenocarcinoma located less than 6 cm from the pectineate line raise the issue of sphincter preservation. Preoperative treatment response can modify the initial indication of surgery. With good response, conservative surgery can be performed with a distal margin less than 2 cm. Conversely a lack of response requires an abdominoperineal resection. Removal technique must emphasize a total mesorectal excision and a prevention of urosexual complications. Intersphincteric resection allows to increase distal margin without continence dysfunction. Regional lymphadenectomy doesn't increase regional control. Digestive tract reconstruction combines coloanal anastomosis and J colonic pouch whenever anatomical conditions are favorable. Long-term follow up should validate this therapeutic approach.
Rouanet
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Chirurgie A1, CRLC Val d'Aurelle, Montpellier.
D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery; D052776:Female Urogenital Diseases / Q000517:prevention & control; D006801:Humans; D008197:Lymph Node Excision; D052801:Male Urogenital Diseases; D018365:Neoplasm, Residual; D011183:Postoperative Complications / Q000517:prevention & control; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*