Mbbs , Mrcs , Facs

Cancer of the large bowel is the third most common cancer diagnosed in both men and women in the United States with the exclusion of skin cancers. The American Cancer Society’s estimates for the number of colorectal cancer cases in the United States for 2014 were 96,830 new cases of colon cancer and 40,000 new cases of rectal cancer.1 Surgeons play a critical role in the management of rectal cancer, both early and advanced. Surgery represents the mainstay of therapy in early-stage rectal cancer and is frequently warranted in advanced cases for palliation. Complete resection and retention of gastrointestinal continuity with low recurrence rates are the ultimate goal in treating localized disease. Surgery for rectal cancer differs in a number of ways from surgery for colon cancer. The rectum represents the terminal 12 cm of the gastrointestinal tract and is confi ned within the bony pelvis. Moreover, the rectum is enveloped by discrete facial layers circumferentially and by a mesorectum posteriorly that bears the lymph node drainage. These anatomic differences make surgery for rectal cancer more challenging and historically associated with higher recurrence rates. Advanced local disease and local recurrences in the pelvis are symptomatically devastating. Adhering to the bloodless facial planes and avoiding violation of the mesorectum result in reduced recurrence rates.2 Local recurrence in rectal cancer essentially represents a failure of surgical therapy and is avoidable in the majorly of cases.3 Another signifi cant difference from colon cancer is the use of radiation therapy in the management of rectal cancer. Being isolated in the pelvis, the rectum lends itself to treatment by radiation therapy with tolerable side effects. Radiation has been shown to reduce local recurrences in rectal cancer. A plethora of approaches have been described in the treatment of rectal cancer, both perineal and abdominal. One must keep in mind the adequacy of surgical resection whenever a certain procedure is contemplated.