Current Strategies in the Management of Adenocarcinoma of the Rectum

In 2012, rectal cancer affected 40,290 Americans. Colon and rectal cancer resulted in a mortality of 51,690 individuals during the same year [1]. Patients affected with rectal cancer who have a clinical stage II (T3-T4, NO, MO) or III (Any T, N1-N3, M0) tumor are treated with preoperative chemoradiation (CRT) followed by surgical intervention 5-10 weeks after the last CRT treatment. An adequate oncologic operation involves removal of the tumor and the entire mesorectum (total mesorectal excision). This has been demonstrated to decrease local recur‐ rence substantially as the lymphatic drainage of the rectum is contained within the investing fascia (mesorectum). Distal rectal tumors involving the anorectal sphincter complex are classically treated with an abdominoperineal resection (APR); whereas, more proximal tumors might be treated with an anterior protosigmoidectomy with a primary colorectal anastomosis (LAR). There has been a substantial shift in the number of APR operations to LAR procedures over the past decade owing to the implementation of new circular stapling devices and the use of neoadjuvant CRT.