Promising Rectal cancer Sphincter Preservation Techniques

Abstract

Background:  A complete dissection of the mesorectum and rectum is made down to the pelvic floor. Transanal local excision can be used for management of selected rectal cancers for many decades.  It allows removing rectal tumors through the anus .Transanal procedures have been performed with minimal morbidity and mortality rates. In addition, early discharge of patients and no requirement for permenant also been contributing to its popularity among surgeons and patients. However, the oncological outcomes of the resection of the primary tumor without proper lymphadenectomy are  related to the risk of lymph node metastases. Therefore, recognition of risk factors for lymph node metastases (LNM) after accurate staging is important for patient selection. Ideally, this procedure would be Selected for patients with small primary tumors , low enough to be accessible through the anus with minimal or no risk for  lymph node metastases as in cases of    T1and T2 rectal cancer especially if there is no lympho-vascular invasion .It is contraindicated especially in cases of T3 and T4 , with lymphovascular invasion , and poor differentiation  rectal tumor in histopatholgy. An anal retractor is used to dilate the anus and  for better  exposure . A lone-star retractor photo, may be used . Some surgeons prefer  traction sutures to be used  and  placed laterally to the lesion to enhance exposure . A line of dissection with a margin of 1 cm is made with electrocautery circumferentially. The depth of resection should always reach the mesorectal fat to provide a maximal radial margin The defect in the rectal wall is then closed  in a running suture, preferably with an absorbable material.