Rectal cancer: the surgical options.

The hypothesis is considered that the tissue block relevant to optimal cure encompasses the integral visceral mesentery of the hind gut, or mesorectum. Surgical technique can recreate the tissue planes around an intact globular specimen which must not be torn or the margin compromised. This emphasis on the "perfect tumour package" has reduced the local recurrence rates in a consecutive personal series of 333 rectal cancer operations to 4% in those operated upon for cure. If patients with metastases or residual disease at presentation are included, the figure increases to 7%. Introduction of selective pre-operative high dose radiotherapy (DXT) for locally unfavourable cancers has combined with further attention to surgical detail to achieve a 5-year follow-up period (January 1990-January 1995) without a single case of locally recurrent disease. Problems remain with healing of the ultra-low anastomosis.