Transanal abdominal transanal proctosigmoidectomy with descending coloanal anastomosis (the TATA procedure) for low rectal cancer treated with chemoradiation
Historically speaking, treatment of rectal cancer has been based on the stage of the tumor at presentation and its height in the rectum. In the past treatment was an abdominal perineal resection with end permanent colostomy. That being the case, it made perfect sense to measure tumors from the anal verge. This was typically done with a rigid sigmoidoscope so that a constant measurement could be obtained. Anatomically however, there is a high variability in the length of the anal canal. The canal itself can be anywhere from 5mm to 5 cm in length depending upon the size and physique of the patient. The anal verge is where the epithelialized skin is encountered. The proximal margin of the anal canal is at the anorectal ring. The dentate line marks the midpoint. Therefore, a tumor at the 5 cm level measured from the anal canal could range anywhere in this location from the mid rectum to the upper aspects of the anal canal, depending on the anal canal length.
KeywordsRectal Cancer Anal Canal Total Mesorectal Excision Local Recurrence Rate Coloanal Anastomosis
Unable to display preview. Download preview PDF.
- Hyams DM, Mamounas EP, Petrelli N, Rockette H, Jones J, Wieand HS, Deutsch M, Wickerham DL, Fisher B, Wolmark N (2004) A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Adjuvant Breast Can Bowel Protocol R-03. Dis Colon Rectum 40(2): 131–139CrossRefGoogle Scholar
- Wibe A, Syse A, Andersen E, Tretli H, Myrvold H, Soreide O on behalf of the Norwegian Rectal Cancer Group (2004) Oncologic outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior versus abdominoperineal resection. Dis Colon Rectum 47(1): 48–58PubMedCrossRefGoogle Scholar
- Kapiteijn E, Maeijnen C, Nagtegaal I, Putter H, Steup W, Wiggers T, Rutten H, Pahlman L, Glimelius B, Han J, Krieken JM, Leer J, van de Velde JH (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. For the Dutch Colorectal Cancer Group. N Engl J Med 345: 638–664PubMedCrossRefGoogle Scholar
- Latkauskas R, Pauzas H, Gineikiene Im Janciauskiene R, Juozaityte Em Saladzinskas Z, Tamelis A, Pavalkis D (2012) Initial results of randomized controlled trial comparing clinical and pathological downstaging of rectal cancer after preoperative short-course radiotherapy or long-term chemoradiotherapy, both with delayed surgery. Colorectal Dis 14(3): 294–298PubMedCrossRefGoogle Scholar
- Marks G, Marks J, Mohiuddin M, Brady L (1998) Radical sphincter preserving surgery with coloanal anastomosis following high-dose external radiation for the very low lying rectal cancer. In: Schlag P (ed) Recent results in cancer research, vol 146. Springer, Berlin, pp 161–174Google Scholar
- Marks G, Mohiuddin M (1983) Sphincter preservation for rectal cancer and the role of full dose preoperative radiation therapy. Int J Radiat Oncol Biol Phys 9(Suppl l): 110Google Scholar
- Marks G, Mohiuddin M, Masoni L, et al (1992) High-dose preoperative radiation therapy as the key to extending sphincter preservation surgery for cancer of the distal rectum. Surg Oncol Clin N Am 1: 71–86Google Scholar