Fragmento

In the United States, more than 150,000 new cases of colorectal cancer are diagnosed annually. Of these, 40,000 (26.6%) occur in the rectum. Traditional therapy for this disease has consisted of a low anterior resection for tumors arising in the upper third of the rectum and abdominoperineal resection of the anus and rectrosigmoid for tumors arising in the mid and lower rectum. With the advent of stapling devices in the mid-1970’s, the number of patients receiving a permanent coloctomy declined as lesions confined to the mid-rectum could be resected usign the triple stapling technique. At about teh same time, other advances occurred in the management of low rectal cancers. Tecniques of coloanal and ileonal anastomosis were popularised in the management of patients with inflamatory bowel disease involving the entire rectum. Althogh these techniques can be utilised in the management of low rectal cancers, there is a significant difference in technique when dealing with a benign versus a malignant condition. For instance, ileonal pouch anastomosis in the treatment of patients with ulcerative colitis requires that a significant portion of the muscle of the lower rectum be preserved. Thus, a mucosal protectomy, as opposed to a total protectomy, is commonly practised for benign disease. In addition, it has been established that a minimum of a 2-cm. distal margin be required for good local control after a low rectal resection. This often means sacrificin a significant portion of the sphincteric mechanism, or the nerve supply to it, thereby rendering patients dysfuntional as far as rectal continence is concerned.

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2004-08-03   |   859 visitas   |   Evalua este artículo 0 valoraciones

Vol. 17 Núm.1. Enero-Diciembre 2001 Pags. 23-25 Med Hoy 2001; 17(1)