Most appropriate management of advanced stage rectal carcinoma
(B) Abdominoperineal resection # 'RECTAL CARCINOMA' located at 5 cm from the anal verge lies in the lower rectum.> Considering the conventional methods of treatments Anterior resection is possible for tumors of upper 2/3rd of rectum Abdominoperineal resection is indicated for tumors of lower 1/3rd of rectum> General site specific plan> Upper Rectum (> 11 cm) Anterior Resection , Mid Rectum (6-11 cm) Low Anterior resection , Lower Rectum (< 6 cm) Abdominal- perineal resection> Note: Length of rectum is about 12 to 15 cm and the anal canal is about 4 cm, any tumor 5 cm from anal verge would thus lie at lower rectum.> General considerations for tumors in lower Rectum: Abdominoperineal Resection (APR) is the gold standard for the treatment of distal rectal cancer. 'APR' involves complete excision of rectum and anus, by concomitant dissection through abdomen and perineum, with permanent closure of perineal rafe and creation of an end colostomy. The most significant disadvantage of this procedure is that it sacrifices the sphincter mechanism and hence now focus is shifting towards a number of sphincter sparing procedures.> It is important however to note here that the information provided is too limited to comment upon the possibility of performing sphincter saving procedures such as local resection or a posterior proctotomy.> Sphincter sparing procedures may be carried out for Young patients who have a favourable body habitus Patients with good preoperative sphincter function Lack of sphincter involvement by tumor Limited extension of tumor into rectal wall (T1 or T2 lesions) Low grade tumors> Sphincter sparing procedures include: Colonal anastomosis Local excision Transanal excision Trans sphincteric excision Posterior proctotomy (Kraske procedure)
Anterior resection
Abdominoperineal resection
Proximal colostomy
Ileostomy
Miscellaneous