摘要
Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal Plan E for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic Micro Surgery(TEM) and Trans Anal Minimally Invasive Surgery(TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery.
Low rectal cancer is traditionally treated by abdominoperinealresection. In recent years, several newtechniques for the treatment of very low rectal cancerpatients aiming to preserve the gastrointestinal continuityand to improve both the oncological as well asthe functional outcomes, have been emerged. Literaturesuggest that when the intersphincteric resection isapplied in T1-3 tumors located within 30-35 mm fromthe anal verge, is technically feasible, safe, with equaloncological outcomes compared to conventional surgeryand acceptable quality of life. The Anterior PerinealPlanE for Ultra-low Anterior Resection technique,is not disrupting the sphincters, but carries a highcomplication rate, while the reports on the oncologicaland functional outcomes are limited. TransanalEndoscopic MicroSurgery （TEM） and TransAnal MinimallyInvasive Surgery （TAMIS） should represent thetreatment of choice for T1 rectal tumors, with specificcriteria according to the NCCN guidelines and favorablepathologic features. Alternatively to the standardconventional surgery, neoadjuvant chemo-radiotherapyfollowed by TEM or TAMIS seems promising for tumorsof a local stage T1sm2-3 or T2. Transanal TotalMesorectal Excision should be performed only whena board approved protocol is available by colorectalsurgeons with extensiveexperience in minimally invasiveand transanal endoscopic surgery.
