Sphincter preservation in rectal cancer

Sphincter preservation is a major goal in the treatment of rectal cancer. For selected patients with T1–2 disease, local excision followed by postoperative combined modality therapy is a reasonable alternative to an abdominoperineal resection. However, for patients with T3 disease, the local recurrence with this approach is approximately 25% and they are treated more effectively with preoperative combined modality therapy. In patients who undergo a prospective clinical assessment and are declared to require an abdominoperineal resection, preoperative radiation therapy, either alone or when combined with chemotherapy, allows approximately 80% to undergo a low anterior resection/coloanal anastomosis. The majority have good-to-excellent sphincter function. These conservative approaches may be an alternative to an abdominoperineal resection in selected patients. Received: August 7, 1998