[Sphincter-preserving operations in the treatment of carcinoma of the middle and lower third of the rectum].

The prerequisites for sphincter-salvaging interventions in the operative management of carcinoma of the middle and lower third of rectum are analyzed. Reference is made to 96 scientific publications of the issue, with due consideration given to the anatomical and physiological prerequisites for coloanal anastomoses. Updated knowledge of intramural diffusion of the neoplastic process in distal direction promotes the performing of ablastic surgical intervention with resection line 2 cm beneath the tumor. The practical implications of total mesorectal excision for reducing local recurrences are underscored. Analysis of the summed up literature data warrant the assumption that in the event of differentiated carcinoma of the rectum, located 1.5-2 cm above linea dentata, sphincter-salvaging operation should be undertaken with a priority given to direct manual coloanal, transanal anastomosis. This type of surgical interventions are attractive on account of the likelihood to preserve the anal sphincter complex--a fact having an essential practical bearing on the lifestyle of patients. Eventual local relapses lend themselves readily to diagnosis and treatment by abdominoperineal extirpation. Thus the latter may be deferred in time, and in most patients it may prove unnecessary altogether.