Abstract

PEDROZA, Audel. Surgical treatment of rectal cancer: bibliographic review. rev. colomb. cir. [online]. 2014, vol.29, n.3, pp.230-242. ISSN 2011-7582.

Accurate staging has a critical role in the decision-making process of patients with rectal cancer. The four most commonly used imaging modalities in the pretherapeutical staging include endoscopic ultrasound, computerized tomography, magnetic resonance imaging and positron emission tomography. Locoregional tumor control in rectal cancer surgery has improved significantly over the last 15 years, after the introduction of total mesorectal excision (TME), which leads to the complete removal of the intact mesorectum including the lymphatics, lymph nodes, nerves, and vascular supply. At the present time, given the improved local control, acute and long-term toxicity profile, and sphincter preservation rate, patients who require combined modality therapy should receive concomitant radiochemotherapy preoperatively.The ultimate goal of the treatment of rectal cancer is to cure the disease while preserving function and quality of life. Total mesorectal excision (TME), the surgical removal of the rectum and its mesorectal envelope, is the accepted standard approach for the treatment of rectal cancer. Patients with tumors located in the middle or upper rectum often undergo an anterior or low anterior resection, preserving the anal sphincter, whereas patients with distal tumors require a complete abdominoperineal resection of the rectum, resulting in permanent colostomy. Patients with early-stage (stage I) rectal cancer who undergo this aggressive surgical approach benefit from a high cure rate, with 5-year survival rates reported between 87 % to 90 %. TME, however, is a major operation that is accompanied by significant mortality (1 %–6 %) and considerable morbidity.

Keywords : rectum; rectal neoplasms; colonic neoplasms; surgery; neoadjuvant therapy.

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