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Surgical resection of primary rectal adenocarcinoma

Ronald Bleday, MD
David Shibata, MD
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD


Surgery is the cornerstone of curative therapy for patients with resectable rectal adenocarcinoma [1]. Surgery can be used as the sole treatment modality or in combination with chemotherapy and/or radiation therapy, depending on the stage of disease. The primary goal of surgery is the complete removal of the rectal cancer. Secondary goals include preservation of anorectal sphincter function and bowel continuity when possible.

The surgical oncologic principles for resecting rectal cancer, including the anatomy, criteria for procedure selection, and preoperative management are discussed here. The procedure options and approaches are reviewed separately.


The pertinent components of the anatomy of the rectum are reviewed below (figure 1).

Rectum — The rectum lacks taeniae, epiploic appendices, haustra, and a well-defined mesentery [2]. In women, the anterior rectum is in close proximity to the posterior vagina and uterine cervix (figure 2 and figure 3 and figure 4). In men, it is behind the bladder, vas deferens, seminal vesicles, and prostate (figure 5).

The precise description of the upper and lower limits of the rectum varies between anatomists and surgeons. Generally accepted surgically, the rectum is 12 to 15 cm in length, the rectosigmoid junction is identified at the sacral promontory, and the distal limit is the dentate line, the point at which the squamous mucosa of the anus transitions to the columnar mucosa of the rectum (figure 6). The dentate line is located in the middle of the anorectal ring. The rectum occupies the sacral concavity and ends 2 to 3 cm proximal to the tip of the coccyx. The location of a rectal cancer is identified by the distance from the dentate line.


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Literature review current through: Sep 2016. | This topic last updated: Dec 8, 2015.
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