Surgical Principles of Rectal Cancer

Published:March 09, 2022DOI:


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        • Heald R.J.
        • Moran B.J.
        Embryology and anatomy of the rectum.
        Semin Surg Oncol. 1998; 15: 66-71
        • Najarian M.M.
        • Belzer G.E.
        • Cogbill T.H.
        • et al.
        Determination of the peritoneal reflection using intraoperative proctoscopy.
        Dis Colon Rectum. 2004; 47: 2080-2085
        • Gollub M.J.
        • Maas M.
        • Weiser M.
        • et al.
        Recognition of the anterior peritoneal reflection at rectal MRI.
        AJR Am J Roentgenol. 2013; 200: 97-101
        • Sato K.
        • Sato T.
        The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia.
        Surg Radiol Anat. 1991; 13: 17-22
        • DiDio L.
        • Diaz-Franco C.
        • Schemainda R.
        • et al.
        Morphology of the middle rectal arteries.
        Surg Radiol Anat. 1986; 8: 229-236
        • Bilhim T.
        • Pereira J.A.
        • Tinto H.R.
        • et al.
        Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography.
        Surg Radiol Anat. 2013; 35: 517-522
        • Havenga K.
        • DeRuiter M.C.
        • Enker W.E.
        • et al.
        Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer.
        Br J Surg. 1996; 83: 384-388
        • Ernest Miles W.
        A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon.
        Lancet. 1908; 172: 1812-1813
        • Dixon C.F.
        Anterior resection for malignant lesions of the upper part of the rectum and lower part of the sigmoid.
        Ann Surg. 1948; 128: 425-442
        • Goligher J.C.
        • Dukes C.E.
        • Bussey H.J.
        Local recurrences after sphincter saving excisions for carcinoma of the rectum and rectosigmoid.
        Br J Surg. 1951; 39: 199-211
        • Heald R.J.
        The 'Holy Plane' of rectal surgery.
        J R Soc Med. 1988; 81: 503-508
        • MacFarlane J.K.
        • Ryall R.D.
        • Heald R.J.
        Mesorectal excision for rectal cancer.
        Lancet (London, England). 1993; 341: 457-460
        • Heald R.J.
        • Husband E.M.
        • Ryall R.D.
        The mesorectum in rectal cancer surgery--the clue to pelvic recurrence?.
        Br J Surg. 1982; 69: 613-616
        • You Y.N.
        • Hardiman K.M.
        • Bafford A.
        • et al.
        The American Society of colon and rectal surgeons clinical practice guidelines for the management of rectal cancer.
        Dis Colon Rectum. 2020; 63: 1191-1222
        • Kang J.
        • Hur H.
        • Min B.S.
        • et al.
        Prognostic impact of inferior mesenteric artery lymph node metastasis in colorectal cancer.
        Ann Surg Oncol. 2011; 18: 704-710
        • Bonnet S.
        • Berger A.
        • Hentati N.
        • et al.
        High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery: impact on the gain in colon length and implications on the feasibility of anastomoses.
        Dis Colon Rectum. 2012; 55: 515-521
        • Komen N.
        • Slieker J.
        • De Kort P.
        • et al.
        High tie versus low tie in rectal surgery: comparison of anastomotic perfusion.
        Int J Colorectal Dis. 2011; 26: 1075-1078
        • Mari G.M.
        • Crippa J.
        • Cocozza E.
        • et al.
        Low ligation of inferior mesenteric artery in laparoscopic anterior resection for rectal cancer reduces genitourinary dysfunction: results from a randomized controlled trial (HIGHLOW Trial).
        Ann Surg. 2019; 269: 1018-1024
        • Fujii S.
        • Ishibe A.
        • Ota M.
        • et al.
        Short-term and long-term results of a randomized study comparing high tie and low tie inferior mesenteric artery ligation in laparoscopic rectal anterior resection: subanalysis of the HTLT (High tie vs. low tie) study.
        Surg Endosc. 2019; 33: 1100-1110
        • Ueno H.
        • Mochizuki H.
        • Hashiguchi Y.
        • et al.
        Preoperative parameters expanding the indication of sphincter preserving surgery in patients with advanced low rectal cancer.
        Ann Surg. 2004; 239: 34-42
        • Andreola S.
        • Leo E.
        • Belli F.
        • et al.
        Distal intramural spread in adenocarcinoma of the lower third of the rectum treated with total rectal resection and coloanal anastomosis.
        Dis Colon Rectum. 1997; 40: 25-29
        • Bujko K.
        • Rutkowski A.
        • Chang G.J.
        • et al.
        Is the 1-cm rule of distal bowel resection margin in rectal cancer based on clinical evidence? A systematic review.
        Ann Surg Oncol. 2012; 19: 801-808
        • Quirke P.
        • Dixon M.F.
        • Durdey P.
        • et al.
        Local recurrence of rectal adenocarcinoma due to inadequate surgical resection.
        Lancet. 1986; 328: 996-999
        • Agger E.A.
        • Jorgren F.H.
        • Lydrup M.A.
        • et al.
        Risk of local recurrence of rectal cancer and circumferential resection margin: population-based cohort study.
        Br J Surg. 2020; 107: 580-585
        • Quirke P.
        • Steele R.
        • Monson J.
        • et al.
        Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial.
        Lancet. 2009; 373: 821-828
        • Nagtegaal I.D.
        • Marijnen C.A.
        • Kranenbarg E.K.
        • et al.
        Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit.
        Am J Surg Pathol. 2002; 26: 350-357
        • Taylor F.G.
        • Quirke P.
        • Heald R.J.
        • et al.
        Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study.
        J Clin Oncol. 2014; 32: 34-43
        • Ruppert R.
        • Junginger T.
        • Ptok H.
        • et al.
        Oncological outcome after MRI-based selection for neoadjuvant chemoradiotherapy in the OCUM rectal cancer trial.
        Br J Surg. 2018; 105: 1519-1529
        • Beyond TMEC
        Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes.
        Br J Surg. 2013; 100: 1009-1014
        • Christou N.
        • Meyer J.
        • Toso C.
        • et al.
        Lateral lymph node dissection for low rectal cancer: Is it necessary?.
        World J Gastroenterol. 2019; 25: 4294-4299
        • Kondo H.
        • Yamaguchi S.
        • Hirano Y.
        • et al.
        Is prophylactic lateral lymph node dissection needed for lower rectal cancer? A single-center retrospective study.
        BMC Surg. 2021; 21: 261
        • Nelson H.
        • Sargent D.J.
        • Wieand H.S.
        • et al.
        • Clinical Outcomes of Surgical Therapy Study G
        A comparison of laparoscopically assisted and open colectomy for colon cancer.
        N Engl J Med. 2004; 350: 2050-2059
        • Guillou P.J.
        • Quirke P.
        • Thorpe H.
        • et al.
        Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial.
        Lancet (London, England). 2005; 365: 1718-1726
        • Fleshman J.
        • Branda M.
        • Sargent D.J.
        • et al.
        Effect of laparoscopic-assisted resection vs open resection of stage ii or iii rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial.
        JAMA. 2015; 314: 1346-1355
        • Jayne D.G.
        • Guillou P.J.
        • Thorpe H.
        • et al.
        Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group.
        J Clin Oncol. 2007; 25: 3061-3068
        • Stevenson A.R.
        • Solomon M.J.
        • Lumley J.W.
        • et al.
        Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial.
        JAMA. 2015; 314: 1356-1363
        • van der Pas M.H.
        • Haglind E.
        • Cuesta M.A.
        • et al.
        Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial.
        Lancet Oncol. 2013; 14: 210-218
        • Bonjer H.J.
        • Deijen C.L.
        • Abis G.A.
        • et al.
        A randomized trial of laparoscopic versus open surgery for rectal cancer.
        N Engl J Med. 2015; 372: 1324-1332
        • Jeong S.Y.
        • Park J.W.
        • Nam B.H.
        • et al.
        Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial.
        Lancet Oncol. 2014; 15: 767-774
        • Acuna S.A.
        • Chesney T.R.
        • Ramjist J.K.
        • et al.
        Laparoscopic versus open resection for rectal cancer: a noninferiority meta-analysis of quality of surgical resection outcomes.
        Ann Surg. 2019; 269: 849-855
        • Pędziwiatr M.
        • Małczak P.
        • Mizera M.
        • et al.
        There is no difference in outcome between laparoscopic and open surgery for rectal cancer: a systematic review and meta-analysis on short- and long-term oncologic outcomes.
        Tech Coloproctol. 2017; 21: 595-604
        • Wei B.
        • Zheng Z.
        • Fang J.
        • et al.
        Effect of denonvilliers' fascia preservation versus resection during laparoscopic total mesorectal excision on postoperative urogenital function of male rectal cancer patients: initial results of Chinese PUF-01 randomized clinical trial.
        Ann Surg. 2021; 274: e473-e480
        • Rullier E.
        • Denost Q.
        • Vendrely V.
        • et al.
        Low rectal cancer: classification and standardization of surgery.
        Dis Colon Rectum. 2013; 56: 560-567
        • Tao Y.
        • Han J.G.
        • Wang Z.J.
        Extralevator abdominoperineal excision for advanced low rectal cancer: where to go.
        World J Gastroenterol. 2020; 26: 3012-3023
        • Jafari M.D.
        • Pigazzi A.
        • McLemore E.C.
        • et al.
        Perfusion assessment in left-sided/low anterior resection (PILLAR III): a randomized, controlled, parallel, multicenter study assessing perfusion outcomes with PINPOINT near-infrared fluorescence imaging in low anterior resection.
        Dis Colon Rectum. 2021; 64: 995-1002
        • Neutzling C.B.
        • Lustosa S.A.
        • Proenca I.M.
        • et al.
        Stapled versus handsewn methods for colorectal anastomosis surgery.
        Cochrane Database Syst Rev. 2012; (Cd003144)
        • Parks A.G.
        Transanal technique in low rectal anastomosis.
        Proc R Soc Med. 1972; 65: 975-976
        • Gordon P.H.
        Chapter 23: Malignant neoplasms of the rectum.
        in: Gordon P.H. Nivatvongs S. Principles and Practice of Surgery for the Colon, Rectum, and Anus. 3rd. CRC Press, Boca Raton2007: 489-643
        • Brown C.J.
        • Fenech D.S.
        • McLeod R.S.
        Reconstructive techniques after rectal resection for rectal cancer.
        Cochrane Database Syst Rev. 2008; (Cd006040)
        • Heriot A.G.
        • Tekkis P.P.
        • Constantinides V.
        • et al.
        Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection.
        Br J Surg. 2006; 93: 19-32
        • Ho Y.H.
        • Brown S.
        • Heah S.M.
        • et al.
        Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates.
        Ann Surg. 2002; 236: 49-55
        • Hou S.
        • Wang Q.
        • Zhao S.
        • et al.
        Safety and efficacy of side-to-end anastomosis versus colonic J-pouch anastomosis in sphincter-preserving resections: an updated meta-analysis of randomized controlled trials.
        World J Surg Oncol. 2021; 19: 130
        • Ricciardi R.
        • Roberts P.L.
        • Marcello P.W.
        • et al.
        Anastomotic leak testing after colorectal resection: what are the data?.
        Arch Surg. 2009; 144 ([discussion 402–11]): 407-411
        • Ahmad N.Z.
        • Abbas M.H.
        • Khan S.U.
        • et al.
        A meta-analysis of the role of diverting ileostomy after rectal cancer surgery.
        Int J Colorectal Dis. 2021; 36: 445-455
        • McDermott F.D.
        • Heeney A.
        • Kelly M.E.
        • et al.
        Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks.
        Br J Surg. 2015; 102: 462-479
        • Ambe P.C.
        • Zarras K.
        • Stodolski M.
        • et al.
        Routine preoperative mechanical bowel preparation with additive oral antibiotics is associated with a reduced risk of anastomotic leakage in patients undergoing elective oncologic resection for colorectal cancer.
        World J Surg Oncol. 2019; 17: 20
        • Menahem B.
        • Lubrano J.
        • Vallois A.
        • et al.
        Early Closure of defunctioning loop ileostomy: is it beneficial for the patient? A meta-analysis.
        World J Surg. 2018; 42: 3171-3178
        • Habib K.
        • Gupta A.
        • White D.
        • et al.
        Utility of contrast enema to assess anastomotic integrity and the natural history of radiological leaks after low rectal surgery: systematic review and meta-analysis.
        Int J Colorectal Dis. 2015; 30: 1007-1014