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Rectal cancer: Surgical techniques

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 rectal adenocarcinoma [1]. Depending upon the clinical stage, size, and location of the primary tumor, a rectal cancer can be treated with either local or radical excision. A local excision is usually performed transanally. A radical excision is performed transabdominally with either a sphincter-sparing procedure or an abdominal perineal resection. Rectal cancers that have invaded adjacent organs may require a multivisceral resection.

In this topic, we review various surgical techniques that are used to treat rectal cancer. A stepwise approach to selecting the appropriate surgical technique is outlined in an algorithm and described in another topic (algorithm 1). (See "Overview of the management of rectal adenocarcinoma", section on 'Management according to initial clinical stage'.)

The surgical anatomy of the rectum, general principles of rectal surgery for cancer, choices of operative approaches (open versus laparoscopic), and the treatment of primary rectal squamous cell carcinomas are discussed in other topics. (See "Rectal cancer: Surgical principles" and "Clinical features, staging, and treatment of anal cancer", section on 'Rectal squamous cell cancers'.)


Local excision is an appropriate therapy for patients who have early-stage rectal cancer without high-risk features and for those with more advanced diseases but who are medically unfit for radical surgery (algorithm 1).

Local excision permits removal of both the tumor and adjoining rectal tissue in one specimen (ie, full thickness excision) without tumor fragmentation, which permits pathologic assessment of inked margins, histologic differentiation, vascular involvement, and depth of invasion. However, it does not excise or stage mesorectal lymph nodes and therefore could miss nodal metastasis or tumor cell deposits in the mesorectum. (See "Overview of the management of rectal adenocarcinoma", section on 'Clinical/pathologic T1N0' and "Overview of the management of rectal adenocarcinoma", section on 'Clinical T2N0'.)

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Literature review current through: Nov 2017. | This topic last updated: Jun 13, 2017.
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