Technique of per anal excision for carcinoma of the low rectum.

Per anal excision is suitable for rectal carcinoma that is less than 3 cm and has not invaded into the muscular layer of the rectum. The upper margin of the lesion should not be greater than 7 cm from the anal verge. The entire lesion is excised in its full thickness with a 1.5 cm to 2 cm normal margin, using electrocautery. It is important that the specimen is carefully examined by the pathologist for completeness of the excision and grade of the carcinoma. Abdominoperineal resection should be considered in good risk patients if adequate margins cannot be achieved and if the carcinoma is a high pathologic grade.