ABSTRACT
Rectal carcinoma is still one of the most frequent cancers in so-called developed countries.1,2 Complete tumour removal is the only measure that gives prospects of cure for the patient. During the last three decades, better survival of all afflicted has been achieved by an increase in the number of curative (i.e. R0) resections and by a decrease in perioperative mortality. Apart from this, in the opinion of many authors,3-5 no substantial improvement of prognosis has been attained. The most important prognostic factor is the tumour stage according to UICC or Dukes. Next to this the individual surgeon performing the operation is of decisive importance.6,7 There is a great variability between institutions and surgeons with regard to local recurrence rates and overall results of surgery.8 Thus, the comments of one of the pioneers in abdominal surgery, the famous German surgeon Johann von Mikulicz, dating from the year 1903 is still valid:9 ‘Wenn wir auch heute schon sagen können, dass das Darmcarcinom eines der dankbarsten Gebiete der Abdominalchirurgie abgiebt, so lassen unsere Resultate doch manches zu wünschen übrig. Sie müssen durch eine Vervollkommnung der Technik besser werden.’ (‘Although even today we may say that bowel cancer is one of the most satisfactory fields in abdominal surgery, our results leave much to be desired. They must be improved by a perfection of technique.’)
Nowadays, radical resection of the primary lesion is the rule – this is so even in elderly patients and when the entire procedure is only palliative. In general, the resection rate of those operated upon should be near 100% and the operative mortality rate should be below 5%.10,11 First essentials for operative success are good preparation of the bowel and the use of prophylactic antibiotics. Postoperatively, a closemeshed follow-up is necessary, because early recog-
nized metastases or local recurrences can be reoperated upon in some cases with curative intent, and because in 2-3% of cases a second metachronous carcinoma occurs.12 Treatment of recurrences and metastases depends on the individual situation. In these cases, interdisciplinary concepts will probably gain more importance in the future.
