ULTRA-LOW ANTERIOR RESECTION AND COLOANAL POUCH RECONSTRUCTION FOR CARCINOMA OF THE DISTAL RECTUM

Facilitated by an enhanced appreciation for pelvic anatomy and physiol ogy along with a better understanding of patterns of rectal cancer spr ead, great advances have been made in our ability to perform restorati ve resections for an ever-increasing proportion of mid and distal rect al cancers. Whereas oncologic results following a low anterior resecti on were the principal concern 20 years ago, recent efforts have focuse d on improving functional results as well. Aspirations for improved fu nction need to be tempered by the realization that improved sphincter- saving rates must follow improved oncologic results rather than jeopar dize them. Some crucial questions are addressed in this paper: What ar e the variables involved in optimizing the oncologic and functional re sults of a low anterior resection and a coloanal reconstruction? What are the issues involved in selecting a particular coloanal reconstruct ion (straight versus pouch, stapled versus handsewn, with or without f ecal diversion) for a particular patient? Wile is not a good candidate for a coloanal reconstruction?