title: Sphincter-sparing surgery in patients with low-lying rectal cancer: techniques, oncologic outcomes, and functional results.
abstract: BACKGROUND
  Rectal cancer management has evolved into a complex multimodality approach with survival, local recurrence, and quality of life parameters being the relevant endpoints. Surgical treatment for low rectal cancer has changed dramatically over the past 100 years.
  
  
  CONCLUSIONS
  Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons devise and test new techniques for preserving the sphincters, maintaining continuity, and performing oncologically sound ultra-low anterior or local resections. Progress in rectal cancer surgery has been driven by improved understanding of the anatomy and pathophysiology of the disease, innovative surgical technique, improved technology, multimodality approaches, and increased appreciation of the patient's quality of life. The patient with a low rectal cancer, once almost universally destined for impotence and a colostomy, now has the real potential for improved survival, avoidance of a permanent stoma, and preservation of the normal route of defecation.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, ACC 460, Boston, MA, 02114, USA, lbordeianou@partners.org.
authors.forename: Liliana
authors.initials: L
authors.lastname: Bordeianou
authors.forename: Lillias Holmes
authors.initials: LH
authors.lastname: Maguire
authors.forename: Karim
authors.initials: K
authors.lastname: Alavi
authors.forename: Ranjan
authors.initials: R
authors.lastname: Sudan
authors.forename: Paul E
authors.initials: PE
authors.lastname: Wise
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Kaiser
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003672:Defecation / Q000502:physiology; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D018579:Patient Selection; D011788:Quality of Life; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States