Reconstructive rectal surgery

Rectal cancer causes approximately 6000 deaths in the UK each year. The rol e of the surgeon in rectal cancer is to control local disease and minimise the risk of recurrence. Reconstructive rectal surgery for cancer aims to co mbine a safe oncological procedure with the maximum quality of life possibl e. An improved understanding of rectal cancer pathology allied to modern su rgical techniques such as intestinal stapling guns, endoanal anastomoses an d the colonic pouch has led to an increased number of sphincter saving oper ations being performed. We have reviewed the background, technical advances and looked at the future of reconstructive rectal surgery for rectal cance r. Firstly we discuss the work which led to low anterior resection being ac cepted as an oncologically safe operation, followed by an overview of surgi cal techniques that have facilitated low anterior resection for rectal canc er with good functional results for the patient. Lastly, we look at the rol e of radiotherapy and the neosphincter in reducing the need for a permanent stoma. (C) 1999 Published by Elsevier Science Ltd. All rights reserved.