Radical Resection

The majority of patients with operable rectal cancer require a radical proctectomy, as this will minimize the probability of local recurrence and provide accurate staging. The primary goal of radical resection is to remove the rectal tumor and all the adjacent lymph node-bearing tissue (the rectosigmoid mesentery and mesorectum) with clear margins. A secondary goal of radical surgery is to restore bowel continuity providing cure of the rectal cancer is not compromised and that high quality sphincter function can be maintained. All radical resection operations for rectal cancer use an identical proximal, lateral and radial (mesorectal) dissection technique. Recent emphasis has been placed on the technique of total mesorectal excision (TME) in which the mesorectum is sharply mobilized from the presacral space to at least 5 cm beyond the tumor (MacFarlane et al, 1993; Martling et al, 2000). Clear radical margins are obtained by performing a meticulous circumferential pelvic dissection within the endopelvic fascial plane. Appropriately performed TME has decreased local recurrence rates after radical surgery. Management of the distal margin determines whether the proctectomy is sphincter-preserving or sphincter-ablative.

In an anterior resection (AR), the sigmoid, rectum and mesorectum are removed through an abdominal "anterior" approach to the pelvis. ARs may be classified as high, low, or extended-low depending on the extent of rectal mobilization and resection. Intestinal continuity is usually restored after an AR by mobilizing the proximal descending and transverse colon and performing a colorectal or colo-anal anastomosis.

If such an anastomosis is technically impossible or con-traindicated, the surgeon can perform an abdominoperineal resection (APR). This operation combines the dissection of an extended low AR to the levator muscles with the perineal dissection of the anus, anal canal, anal sphincters, levators and surrounding fat to allow an en bloc removal of the specimen. The operation is completed by closing the per-ineal wound and constructing a permanent colostomy, generally using the distal decending or proximal sigmoid colon.

A third operative option, the Hartmann procedure, is used rarely but may be preferred if the cancer has perforated or spread locally making early recurrence likely, or if the patient has preexisting sphincter dysfunction making a low anastomosis unwise. In this procedure, after completing the AR to remove the rectal cancer, the distal rectum is closed and left in situ. An end colostomy is constructed usually from the descending colon.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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