Surgical treatment for rectal cancer. Functional results and side effects of treatment

The evolution of treatment for rectal cancer has resulted in a decline in the number of abdominoperineal resections, an increase in the number of sphincter saving procedures and the development of new operations including continent and perineal colostomies. Each of these must be considered and compared in terms of both their oncological and functional outcome. This paper reviews the evidence from published articles from 1985 until the present day. Recommendations include closure of the perineum with an omentoplasty in patients where an abdominoperineal resection is unavoidable. In cases where a low anastomosis is possible some rectum, however little, should be preserved in order to improve the final functional result. Preoperative radiotherapy at high doses, and radiotherapy or chemo-radiotherapy given postoperatively aggravate functional problems of direct low anastomoses; these are improved by the use of a colonic pouch. Urogenital sequelae can probably be safely avoided or limited by surgery in the mesorectal plane. However, all of these areas require further evaluation and where possible randomised studies.