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Abstract
-Rectal carcinoma is the most common malignancy of the alimentary tract representing about 35% of all rectal tumors.
-The age of incidence of colorectal carcinoma in Egypt is younger than in western counteries .
-In Egypt males are more commonly affected by colorectal carcinoma than females , in contrast to the western world in which a higher incidence of female affection over males . -Advanced investigations including three dimensional MRI , ERUS and colonography are the main tool for local staging, choice of the optimal treatment method, type of resection, candidacy for neoadjuvant therapy and detection of early local recurrence.
-Adequate excision is achieved by total meseorectal excision (TME) (sharp dissection between the parietal and visceral pelvic fascia with complete removal of rectum, meseorectum and pararectal lymph nodes). Further more, it allows for preservation of the pelvic autnomic nerves, therefore reducing the local recurrence rate, bladder and sexual dysfunction.
-The laparoscopic approach offers several potential benefits over laparotomy, including less pain, early return of bowel function, improved postoperative immune function, shorter hospitalization, improved cosmesis and reduced intra-abdominal adhesions.
-On the other hand, inadequate excision, technical difficulty in performing stapled low rectal division and preservation of sphincter function and difficult pelvic dissection after preoperative radiotherapy are met during laparoscopy. This is supported by developing autosutures and double stapling technique in anastomosis.
-Short term preoperative radiotherapy for locally advanced tumors is beneficial for downsizing and downstaging of the tumors allowing sphincter saving procedures. Postoperative chemo-and radiotherapy followed by early and regular follow up of patients after curative resection by tumor markers, imaging and endoscopy are important to reach a high cure rates. -Molecular genetics are likely to impact every aspect of colorectal cancer screening, suviellance, prevention, diagnosis, staging and management especially in familial syndrome of colorectal neoplasms.
It is concluded that: -Sphincter preservation is the rule in upper and middle cancer rectum, and new laparoscopic techniques help in preservation of low rectal cancer .