Surgery of the cancer of the low rectum: towards a conservation of the sphincter

The conventional low former résection with mechanical or manual colo-anal anastomosis is an alternative to the amputation abdomino-périnéale in cancers of the low rectum. The technique of résection inter-sphinctérienne, which includes the ablation of the sphincter intern, allows a conservation sphinctérienne for the rectal tumours juxta and intracanalaires. The néoadjuvants treatments facilitate the preserving surgery by the induction of a down-staging. The results oncologic of conventional colo-anal anastomosis and the résection inter-phinctérienne are similar to those of the amputation abdomino-périnéale, in terms of survival and local control. The limits of the preserving surgery are functional rather than oncologic. The rectal rebuilding by the use of a tank colic decreases the functional disorders after anastomosis coloanale. The evolution of specialization and the development of the surgical techniques direct towards a rate of 10% of amputation abdomino-périnéale in the surgical treatment of rectal cancer.