In view of the distressing disturbances during the first post-operative year, a sphincter-saving operation involving a low anastomosis has very doubtful merits when life expectancy is short. Thus, in a patient with a low rectal carcinoma and distant metastasis, a well functioning abdominal colostomy probably offers a better quality of life. Moreover, although the radicality of the operation is probably equivalent to that after abdominoperineal excision, the development of a local pelvic recurrence will give early and distressing symptoms, which requires abdominoperineal excision. Unfortunately this operation, if possible to perform, will seldom be curative. Therefore a restorative operation for a low-sited rectal cancer should be reserved for mainly limited growths with low-grade malignancy. Endo-anal anastomosis should only be considered for small tumours where adequate distal clearance cannot be obtained even by stapled low anterior resection.
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