Conservative management of invasive rectal cancer: alternative to abdominoperineal resection.

The standard treatment for patients with distal invasive rectal cancer who are unable to undergo a low anterior resection (LAR) is an abdominoperineal resection (APR). Although an APR offers excellent cure rates, it is associated with complications such as urological dysfunction, male impotence, and requires a permanent colostomy. Local excision alone is not adequate. If there is no evidence of gross disease in the pelvis, sphincter-sparing surgery (with negative margins) with adjuvant pelvic radiation therapy may be an alternative to abdominoperineal resection. Further follow-up will be needed to determine if this approach ultimately achieves local control and survival rates similar to an APR.