Limited Surgery for Rectal Cancer

Yoshihiro Moriya

Department of Surgery, National Cancer Center

Local excision, total nerve-sparing operation, endoscopic mucosal resection and LAC are thought to be limited surgical procedures for rectal cancer, if nerve-sparing operations with lymphadenectomy are defined as standard procedures. Among those limited operations, local excision and total nerve-sparing operation are explained in terms of operative indications, techniques and functional results. Local excision consists of trans-anal, trans-sphincteric (Mason') and trans-sacral approches (Kraske'). These operations should be applied to early rectal cancer in which depth of invasion is mucosal or sm1. In cases showing a risk factors for lymphnode metastasis, radical surgery should be applied as an initial treatment. Eligibility criteria for this surgery are more strictly limited in Japan than in Western countries. Total preservation of the autonomic nerves should be applied to early or mp rectal cancer. Long-term urinary and sexual function is good after a total nerve-sparing operation. Rigiscan for NPT is important to estimate erection objectively. We would like indications for limited surgery for rectal cancer to be more frequently applied, based on the progress of adjuvant radiochemotherapy.

Key words
local excision, nerve-sparing operation, early rectal cancer

Reprint requests
Yoshihiro Moriya Departmentof Surgery, National Cancer Center Hospital
5-1-1 Tsukiji, Chuo-ku, Tokyo, 104 JAPAN

Accepted
November 9, 1994

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