ANTERIOR RESECTION FOR RECTAL-CANCER

Anterior resection is the method of choice for the treatment of rectal cancer situated in the upper or middle third of the rectum. Hand-sewn and stapled anastomosis methods have shown comparable results with re gard to the rate of leakage. Standardized preoperative bowel preparati on, antibiotic prophylaxis and a careful surgical technique will lead to a postoperative lethality of below 5% and a surgical complication r ate below 15%. The main functional problems following anterior resecti on consist of incontinence and bladder and sexual dysfunction, but the se can be partly avoided by careful surgical preparation. There is con troversy in the literature concerning the positive effect of a protect ive ileostomy or colostomy. The major principles are: (1) radical rese ction of the tumor, with complete removal of the mesorectum, leaving a minimal distal margin of 2 cm, and (2) a meticulous anastomosis techn ique: tension-free, pulsation blood flow tight.