Sphincter preserving techniques in rectal cancer and their limitations.

For a patient with a tumour in the anal canal or with the inferior margin 5 cm or less from the anal verge an abdominoperineal rectal excision with permanent sigmoid colostomy is the only available treatment. The Turnbull-Cutait pull-through technique involved full mobilization of the rectum, complete eversion of the anorectal stump and pull-through of the colon, the excess of which was resected in the second stage of the operation, followed by suture of the colonic and rectal mucosa. Abdomino sacral resection has been practised by a few surgeons only. Abdominotransanal resection with sutured colo-anal sleeve anastomosis was the operation developed by Sir Alan Parks. In this operation the anorectal stump is not everted through the anus as in the Turnbull-Cutait operation. There has been a great revival of interest in low anterior resections with the introduction of the EEA instrument for stapling the colorectal anastomosis and there is still today a great enthusiasm for this technique. In an attempt to improve the results trial are going on at present to evaluate the importance of a J-configured neo-rectum constructed from the sigmoid or descending colon and stapled to the top of the anal canal or handsutured to the pectinate line after endoanal mucosectomy. Many patients with rectal carcinoma are old and often suffer from intercurrent diseases such as hypertension, diabetes etc. There is considerable postoperative complication. An abdominoperineal resection with a colostomy is by no means outdated for an ultralow or low sited rectal cancer.