The development of sphincter saving surgery for rectal cancer: the long way from a perineal colostomy to restoration of continence

Summary

The treatment of rectal cancer started with the first perineal resection by Lisfranc in 1826. In the beginning of rectal surgery sphincter salvage had no priority. Hochenegg published the first successful rectal resection with preservation of the sphincter in Vienna in 1888. The further development of sphincter salvage was inhibited by the discovery of a high recurrence rate after perineal resection by Miles. He proposed the abdominoperineal resection for all cancers of the rectum independent of their localization. Most surgeons in Europe and USA followed Miles’ proposal, but in Vienna sphincter salvage was further practiced by Hochenegg and his team. Later, his assistant Finsterer developed the abdominosacral resection. Dixon from the Mayo Clinic reported good results with a solely abdominal operation for tumors of the upper part of the rectum, which he called “anterior resection” in contrast to the posterior (perineal and sacral) resections. From this point sphincter salvage became slowly popular, supported by the use of stapling instruments. The final step was the development of techniques to save the sphincter even in tumors of the lower third of the rectum by ultralow resections.