Sphincter-saving Rectal Surgery

Surgical treatment for distal rectal cancer requires a high-level technical skills and knowledge because of these tumors’ intricate relationship to the anal sphincter muscle and sexual organs.  For years, treatment of cancer in the lower rectum often resulted in a permanent stoma or colostomy.  A stoma is an opening made in the abdominal wall where the colon is connected to and the stool is collected in a bag.  However, advanced surgical techniques have been developed which in many cases can remove tumors and “spare” the anal sphincter muscles thus preserving normal bowel function.

Preoperative staging, evaluation and adequate patient selection are critical for successful rectal cancer surgery.  California Colorectal Surgeons uses a multidisciplinary approach in treating and evaluating rectal cancer cases and developing an individual care plan for each patient.  The team includes gastroenterologists, radiologists, pathologists, radiation oncologists, medical oncologists and colorectal surgeons.  Their combined input can determine if a patient is a candidate for sphincter-sparing surgery.

Techniques for Sphincter-sparing surgery include:

1. Neoadjuvant therapy.  This therapy consists of administering radiation and chemotherapy as an outpatient before surgery in order to shrink very large or advanced tumors.  After the neoadjuvant therapy has been completed, the surgeon waits 6 to 8 weeks to allow maximum shrinkage of the tumor.  This treatment greatly reduces the recurrence rate of the tumor and improves chances of avoiding a stoma.

2. Local excision

3. TAMIS

4. Coloanal J-Pouch.  The rectal tumor is removed close to the sphincter muscles. A pouch is then created from the colon above and attached inside the lower rectum or anal canal.  The pouch improves storage capacity and bowel function or control after surgery.

5. Laparoscopic Surgery

6. Robotic Surgery