Tumour Localisation

In tumours reaching the anal canal, or located less than 1 cm from the sphincter, abdomino-perineal resection (APR) is often the only curative surgery which can be realised, with the exception of some small tumours which are conservatively treatable: local excision or proctectomy with intersphincteric resection. In the case of tumours located above 2 cm from the ano-rectal junction, it is almost always possible to preserve the anal sphincter with an onco-logically correct exeresis. In the case of tumours sited between 1 and 2 cm from the anal canal, to achieve a proper distal clearance, we must resort to an inter-sphincteric resection. For tumours whose lower pole is less than 5 cm from the anal verge, a distal resection margin of 2 cm is enough [6], as long as a com plete exeresis of the mesorectum is performed which caudally ends 2-3 cm from the levator plane.

After Heald et al's basic research on total mesorectal excision (TME) [7, 8] the distal section and anastomosis are performed, therefore, behind the anal canal, making the techniques of low, ultra-low and colo-anal anastomosis more routinary. The colorectal anastomosis is defined as low if the rectal stump is over 2 cm long and ultra-low if it is less than 2 cm. If a total proctectomy with TME is necessary, this will be followed by a manual or mechanic colo-anal anastomosis.

Was this article helpful?

0 0
Dealing With Erectile Dysfunction

Dealing With Erectile Dysfunction

Whether you call it erectile dysfunction, ED, impotence, or any number of slang terms, erection problems are something many men have to face during the course of their lifetimes.

Get My Free Ebook

Post a comment