J.Jpn. Surg. Soc.. 118(4): 434-441, 2017

---

Feature topic

FUNCTION-PRESERVING SURGERY FOR RECTAL CANCER

Total mesorectal excision (TME) following preoperative chemoradiation therapy (CRT) is the standard surgical therapy for middle-low rectal cancer. However, preoperative CRT has some adverse effects on anal or sexual function after TME. In Japan, TME plus lateral lymph node dissection has been performed as standard therapy for clinical stage Ⅱ or Ⅲ rectal cancer, and feasible clinical results and good urinary function were reported from a phase Ⅲ clinical trial. Anus-preserving operations for low rectal cancer located close to the anus have advanced in the last 20 years with the establishment of intersphincteric resection (ISR). A Japanese phase Ⅱ trial of ISR for very low rectal cancer was conducted and it showed reasonable local recurrence rates in stage I and anal function at 2 years after stoma closure. A new randomized trial is now ongoing to clarify the superiority of preoperative chemotherapy plus ISR to ISR alone in stage Ⅱ or Ⅲ low rectal cancer. Transanal TME (taTME) could be a useful procedure in lower rectal cancer patients with different pelvic morphology and its use is expanding, especially in Europe. The oncological and functional advantages of performing taTME are expected to be clarified in a new international clinical trial.

---

---

To read the PDF file you will need Adobe Reader installed on your computer.