[Pathologic and anatomic preconditions for radical sphincter preserving operations in carcinoma of the medial and distal rectum].

The contemporary knowledge of the intramural and the extraluminal spreading of the rectal carcinoma in distal direction is taken into account. Based on these data, it is accepted as ablastic, the surgical procedure with resection line at 2 cm below the lowest tumor margin. It is highlighted the value of the total mesorectal excision for decreasing the local recurrence rate. After processing the available scientific data, a conclusion is made, that by localization of differentiated carcinoma at 1.5-2 cm above dentate line, a sphincter preserving operation should be done. A priority is given to the direct manual coloanal, transanal anastomosis. This type of surgical procedures is attractive because of the possibility to preserve the anal sphincter apparatus, which extremely benefits the life quality of the patients. The eventual local recurrences could be easily recognized and treated with abdomino-perineal extirpation. In this way the last could be put off in the time, although most of the patients do not have the need of it at all.