Sphincter-sparing resection for rectal cancer.

Although there is still a place for abdominoperineal resection in the treatment of rectal cancer, the state of the art is sphincter-preserving resection. Even for the lowest of rectal cancers, using a combination of neoadjuvant chemo/radiation, total mesorectal excision, and intersphincteric proctectomy and colonic J-pouch to anal anastomosis, sphincter preservation can be achieved for most patients. The key concept in pushing sphincter preservation forward has been the realization that the deep, circumferential, or lateral margin is all-important. Unless the rectal tumor involves the external sphincter muscle, there is no oncologic need to remove it, and following resection of the tumor, gastrointestinal tract continuity can be restored.