[Rectal carcinoma--oncologically adequate resection].

Abstract

The local recurrence rate is besides distant metastatic spread the most relevant factor for the longterm survival of patients with rectal cancer. Of decisive importance are the experienced surgeon and special techniques such as the precise mesorectal dissection with respect of the holy planes. Total mesorectal excision (TME) for carcinomas of the lower and middle third of the rectum and a sufficient distal margin of 2 cm reduced the local recurrence rate to below 10% and allow sphincter preservation in more than 80%. The local excision is ideal for low-risk-patients with circumscript T1-tumors. In high-risk-patients the operation should be followed by additional chemoradiation therapy. Multivisceral surgery and pelvic exenteration do have a place in patients with locally advanced tumors, which should be treated by neoadjuvant radiochemotherapy. Laparoscopic operations of rectal cancer show first promising results but should, however, be restricted to controlled clinical trials.