Surgery for Rectal Cancer
The rectum is approximately 18 cm in length and is divided into the upper intraperitoneal third and the lower extraperitoneal two-thirds. The surgical approach and clinical outcome of upper rectal tumors are similar to cancer of the colon. As opposed to colon and upper rectal cancer, surgery for locally advanced low and mid rectal cancer has been associated with high local recurrence rates, reportedly as high as 30% until the late 1990s. Two factors that have contributed to a substantial decrease in the local recurrence rate following surgery for locally advanced rectal cancer are completion therapy with radiation, and the adoption of a surgical technique – total mesorectal excision radiation – used to be administered after the operation (termed adjuvant radiotherapy) but is now generally given prior to surgery (called neoadjuvant radiotherapy).