[Current issues in the surgical treatment of rectal cancer].

INTRODUCTION

Three topics associated with surgical treatment of rectal cancer are discussed. The need for standard preoperative irradiation, based on interdisciplinary approach is considered. In the authors' opinion the most urgent task is to increase the number of sphincter saving resections carried out by total mesorectal excision. The principles of surgical therapy for hepatic metastases are discussed.

METHODS

The authors' experience is based on 328 radical resections performed between 1992-2003.

RESULTS

Three periods are compared: we managed to raise the ratio of surgical interventions preserving the rectal sphincter over 60%, and during the last period the results have further improved. Total mesorectal excision is the standard in the department. The morbidity rate--28.8%, 18.6% and 5.3% for suture leak is reduced. During the last eight years in the presence of hepatic metastasis in 20 liver resections were performed.

CONCLUSIONS

In addition to preoperative irradiation considered we recommend treatment consisting of 5x5 Gy for early cancer, and of 60 Gy/6 weeks for a progressed stage. In our opinion, application of atraumatic surgical techniques and up to date circular stapling guns can increase the ratio of sphincter preserving interventions. We hope, the use of total mesorectal excision carried out adequately may reduce morbidity (suture leak, nerve damage--impaired innervation and sexual dysfunction) and the rate of local recurrence and it may improve survival. The only curative treatment of hepatic metastases in colorectal cancers is resection, therefore the authors suggest the possibility of widening the range of surgical indications--more than three metastases in one lobe, even in bilateral involvement.