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NEWER CONCEPTS IN SPHINCTER PRESERVATION IN COLORECTAL CANCER |
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Department of Oncosurgery, The Gujrat Cancer and Research Inst., Ahmedabad-16 Cancer of the colon and rectum is the third most frequent cancer in developed countries and major cause of death in Western world. Approxtmateiy 60% of the patients with rectal cancer undergo a potentially curative resection with subsequent 5-year survival figures of about 50%. Surgical resection of the primary tumor Is the standard of care. The Abdominoperineal resaclion (APR) described by Miles (1908) was a standard in operative management of rectal cancer prior to introduction of circular intraluminal staplers in 1970s. Curative operative management remains divided between low anterior resection, APR and local excision. Modifications in techniques to affect recurrence and survival have been advocated and at the same lime adjuvant therapy trials demonstrating decreases In local recurrence have been instituted. VARIOUS APPROACHES FOR SPHINCTER PRESERVATION 1. Sphincter saving radical resections : -Low anterior resection: End to end/end to side Sutured/stapled. - Abdominoscaral resection d'Alliane's procedure. -Coloanal procedures: Endoanal (Park's) Stapled/sutured Straight/J'pouch. 2. Local therapy : - Excisional Transanal, Paras acral (Krask's) Transsphincteric (York Mason) Transanal Endoscopic Microsurgery - Ablative Endocavitary radiation Electro figuration, Laser, PDT, CryosLirgery 3. Adjuvant Therapy (RT+/- CT): 4. Induction Therapy: (RT+/- CT) : |
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