ABSTRACT
Sphincter-saving low anterior resection is now widely accepted for the treatment of cancer of the middle and lower thirds of the rectum. Long-term survival and local recurrence rates after low anterior resection are similar to those obtained by total excision of the rectum, once the distal resection margin is at least 1 cm. After rectal excision with very low colorectal and coloanal anastomosis (CAA), patients often experience a degree of urgency and increased frequency of defecation which results from loss of the rectal reservoir. In order to improve the functional results, a J-shaped colonic reservoir may be constructed1, 2 and an anastomosis performed between the apex of the reservoir and the anal canal. For ultra-low tumor, an intersphincteric resection may be performed in selected patients to avoid an abdominoperineal resection and a permanent colostomy.3 The authors’ practice is to reserve intersphincteric resection for tumors for motivated patients with T1 or T2 tumors confined to the upper part of the anal canal such that a 1 cm distal margin is feasible.
