Since 1908, abdominal perineal resection, that is, the so-called diversion surgery, has been the standard surgical treatment of rectal cancer. In recent years, the medical profession on increasing awareness of the biological behavior of colorectal cancer, and lymph node metastasis, surgical margin remote-depth study of issues such as quality of life of patients and constant attention, which is reserved anus increasingly popular. After the recent 10 years of continuous research, the current rectal cancer surgery has been basically formed a more consistent understanding of the local recurrence rate without increasing the case should be possible to carry out sphincter preserving surgery. Important influence on whether the insurance dirty factors, including tumor location, size, histological type, differentiation, and the patient's gender and age.
For sphincter preserving surgery on the premise that quality can not be reduced in patients, not because the operation is not complete and increase the risk of local recurrence, but not destroy the anal sphincter. Therefore, the ability to keep the problem of anal cancer directly related to whether the distal resection margin in radical surgery standards. Generally believed that, for well-differentiated histologic type, surgical margin distal 2 cm from the tumor enough, poorly differentiated tumors may be removed 4 cm. For sphincter preserving surgery and abdominoperineal resection in 5-year survival and local recurrence rate is similar to the sphincter preserving surgery does not increase the risk of local recurrence.
The length of the rectum about 15 cm, can be divided into upper, middle, and lower segment. Sphincter preserving surgery for rectal cancer on the run is not controversial; lower rectal cancer unless it is early days, now that the surgery is generally not the anus; the middle of the sphincter preserving surgery in rectal cancer operation, there are certain difficulties, but in theory feasible. The main difficulty is that, after the removal of intestinal lesions docking, manual method of docking is sometimes very difficult, especially for the narrow male pelvis, obese patients. But with the emergence of stapling, the problem is basically solved.
Docking with a stapler risk of anastomotic leakage was significantly lower than the hand-fit, and can shorten the operation time. Studies have reported that the tumor less than 5 cm from the anal verge of patients, of which 77% can be by means of stapler sphincter preserving surgery, local recurrence after surgery is the peak time within 2 years after surgery, 80% -90% of the recurrent in this time, sphincter preserving surgery is the peak time of recurrence 6-9 months after surgery, abdominal perineal resection is the peak time of recurrence 9-12 months after surgery.
Rectal cancer surgery complication mainly of anastomotic leakage. Functional status after surgery is the key to anal surgery can damage the anal sphincter. In the sphincter preserving surgery in a variety of anal anastomosis anorectal surgical techniques and pulled out, but the anal function in surgical recovery bad, only 2% of patients with anal sphincter can be maintained in good condition. Therefore, in general, do not recommend these surgical procedures.