Low Anterior Resection with Coloanal Anastomosis for Rectal Cancer

Conventional low anterior resection with stapled or hand-sewn coloanal anastomosis is an alternative to abdominoperineal resection in selected low rectal cancers. The technique of intersphincteric resection, which includes removal of the internal sphincter, extends the possibility of sphincter preservation to patients with very low rectal tumors. Neoadjuvant treatment facilitates ultralow conservative surgery for locally advanced disease by inducing downstaging. Oncological results of conventional coloanal anastomosis and intersphincteric resection are similar to those of abdominoperineal resection, in terms of local control and survival. The restrictions of conservative surgery appear to be functional rather than oncologic. Rectal reconstruction using a colonic pouch decreases functional gastrointestinal disorders following coloanal anastomosis. The J-pouch is the standard reservoir, whereas the transverse coloplasty and side-to-end anastomosis constitute an alternative. Through utilization of new concepts and optimal surgical techniques for sphincter preservation, abdominoperineal resection should prove necessary for only 10% of rectal cancers.