Rectal cancer: the sphincter-sparing approach.
There is considerable skepticism regarding sphincter-preserving surgery for rectal cancer, and 40% to 60% APR rates are reported in many prospective studies. Despite radical surgery, 20% positive margin rates are frequently reported. Rectal carcinoma responds to preoperative chemoradiation therapy with a 10% to 15% pathologic complete response rate. Preoperative therapy offers an opportunity to reduce the positive margin rate and to reduce the APR rate. Because there is significant tumor regression with preoperative therapy, distal margins of less 1 cm are acceptable and do not result in suture line recurrence. APR rate of less than 10% is feasible and better chemotherapy with radiation therapy will reduce the APR to less than 5%.
Ota
David M
DM
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA. dota@mcw.edu
Jacobs
Lisa
L
Kuvshinoff
Boris
B
D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D009361:Neoplasm Invasiveness; D019651:Plastic Surgery Procedures; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*
D000970:Antineoplastic Agents