Surgical Treatment of Rectal Cancer

  • Ronald Bleday
  • Nelya Brindzei


Approximately 42,000 patients each year are diagnosed with rectal cancer in the USA. Approximately 8,500 die of this disease. Despite remarkable recent advances in new oncologic agents for the treatment of colon and rectal cancer, cure is almost never achieved without surgical resection. However, the current management of rectal cancer is now more varied and complex because of the new approaches with multimodality therapy and the refinements in surgical techniques. For example, small distal rectal cancers with minimal invasion can be treated with a local excision with or without adjuvant therapy. More proximal or more invasive tumors require a “radical” resection. The two most common procedures are the low anterior resection (LAR) and the abdominoperineal resection (APR). Extended resections are occasionally required for patients with cancers that invade or adhere to adjoining structures such as the sacrum, pelvic sidewalls, prostate, or bladder.


  1. 1.
    Floyd CE, Stirling CT, Cohn Jr I. Cancer of the colon, rectum and anus: review of 1,687 cases. Ann Surg. 1966;163(6):829–37.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Reilly JC, Rusin LC, Theuerkauf Jr FJ. Colonoscopy: its role in cancer of the colon and rectum. Dis Colon Rectum. 1982;25(6):532–8.PubMedGoogle Scholar
  3. 3.
    Travieso Jr CR, Knoepp Jr LF, Hanley PH. Multiple adenocarcinomas of the colon and rectum. Dis Colon Rectum. 1972;15(1):1–6.PubMedGoogle Scholar
  4. 4.
    Heald RJ, Bussey HJ. Clinical experiences at St. Mark’s Hospital with multiple synchronous cancers of the colon and rectum. Dis Colon Rectum. 1975;18(1):6–10.PubMedGoogle Scholar
  5. 5.
    Langevin JM, Nivatvongs S. The true incidence of synchronous cancer of the large bowel. A prospective study. Am J Surg. 1984;147(3):330–3.PubMedGoogle Scholar
  6. 6.
    Brahme F, Ekelund GR, Norden JG, Wenckert A. ­Metachronous colorectal polyps: comparison of development of colorectal polyps and carcinomas in persons with and without histories of polyps. Dis Colon Rectum. 1974;17(2):166–71.PubMedGoogle Scholar
  7. 7.
    Dixon AK, Fry IK, Morson BC, et al. Pre-operative ­computed tomography of carcinoma of the rectum. Br J Radiol. 1981;54(644):655–9.PubMedGoogle Scholar
  8. 8.
    Grabbe E, Lierse W, Winkler R. The perirectal fascia: morphology and use in staging of rectal carcinoma. Radiology. 1983;149(1):241–6.PubMedGoogle Scholar
  9. 9.
    Adalsteinsson B, Glimelius B, Graffman S, et al. Computed tomography in staging of rectal carcinoma. Acta Radiol Diagn (Stockh). 1985;26(1):45–55.Google Scholar
  10. 10.
    Freeny PC, Marks WM, Ryan JA, Bolen JW. Colorectal carcinoma evaluation with CT: preoperative staging and detection of postoperative recurrence. Radiology. 1986;158(2):347–53.PubMedGoogle Scholar
  11. 11.
    Thompson WM, Halvorsen RA, Foster Jr WL, et al. Preoperative and postoperative CT staging of rectosigmoid carcinoma. AJR Am J Roentgenol. 1986;146(4):703–10.PubMedGoogle Scholar
  12. 12.
    Kane R. The accuracy of CT, MRI, and ultrasound in the ­detection of hepatic metastatic disease from colon cancer. Abstract. Proceedings of the 76th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Chicago, IL; 1990.Google Scholar
  13. 13.
    Beynon J, Foy DM, Roe AM, et al. Endoluminal ultrasound in the assessment of local invasion in rectal cancer. Br J Surg. 1986;73(6):474–7.PubMedGoogle Scholar
  14. 14.
    Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum. 1985;28(1):42–6.PubMedGoogle Scholar
  15. 15.
    Hildebrandt U, Feifel G, Schwarz HP, Scherr O. Endorectal ultrasound: instrumentation and clinical aspects. Int J Colorectal Dis. 1986;1(4):203–7.PubMedGoogle Scholar
  16. 16.
    Rifkin MD, Wechsler RJ. A comparison of computed tomography and endorectal ultrasound in staging rectal cancer. Int J Colorectal Dis. 1986;1(4):219–23.PubMedGoogle Scholar
  17. 17.
    Beynon J, Roe AM, Foy DM, et al. Preoperative staging of local invasion in rectal cancer using endoluminal ultrasound. J R Soc Med. 1987;80(1):23–4.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Puli SR, Bechtold ML, Reddy JB, Choudhary A, Antillon MR, Brugge WR. How good is endoscopic ultrasound in differentiating various T stages of rectal cancer? Meta-analysis and systematic review. Ann Surg Oncol. 2009;16:254–65.PubMedGoogle Scholar
  19. 19.
    Puli SR, Reddy JB, Bechtold ML, Choudhary A, Antillon MR, Brugge WR. Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a meta-analysis and systematic review. Ann Surg Oncol. 2009;16:1255–65.PubMedGoogle Scholar
  20. 20.
    Beynon J. An evaluation of the role of rectal endosonography in rectal cancer. Ann R Coll Surg Engl. 1989;71(2):131–9.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Hulsmans FJ, Tio TL, Fockens P, et al. Assessment of tumor infiltration depth in rectal cancer with transrectal sonography: caution is necessary. Radiology. 1994;190(3):715–20.PubMedGoogle Scholar
  22. 22.
    Orrom WJ, Wong WD, Rothenberger DA, et al. Endorectal ultrasound in the preoperative staging of rectal tumors. A learning experience. Dis Colon Rectum. 1990;33(8):654–9.PubMedGoogle Scholar
  23. 23.
    Ng A, Recht A, Busse PM. Sphincter preservation therapy for distal rectal cancer: a review. Cancer. 1997;79:671.PubMedGoogle Scholar
  24. 24.
    Gualdi GF, Casciani E, Guadalaxara A, et al. Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings. Dis Colon Rectum. 2000;43(3):338–45.PubMedGoogle Scholar
  25. 25.
    Brown G, Richards CJ, Bourne MW, et al. Morphologic ­predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 2003;227:371–7.PubMedGoogle Scholar
  26. 26.
    Kim NK, Kim MJ, Yun SH, et al. Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer. Dis Colon Rectum. 1999;42(6):770–5.PubMedGoogle Scholar
  27. 27.
    Meyenberger C, Huch Boni RA, Bertschinger P, et al. Endoscopic ultrasound and endorectal magnetic resonance imaging: a prospective, comparative study for preoperative staging and follow-up of rectal cancer. Endoscopy. 1995;27(7):469–79.PubMedGoogle Scholar
  28. 28.
    Blomqvist L, Machado M, Rubio C, et al. Rectal tumour staging: MR imaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography. Eur Radiol. 2000;10(4):653–60.PubMedGoogle Scholar
  29. 29.
    Gastrointestinal Tumor Study Group. Adjuvant therapy of colon cancer: results of a prospectively randomized trial. N Engl J Med. 1984;310(12):737–43.Google Scholar
  30. 30.
    Wallengren NO, Holtas S, Andren-Sandberg A, et al. Rectal carcinoma: double-contrast MR imaging for preoperative staging. Radiology. 2000;215(1):108–14.PubMedGoogle Scholar
  31. 31.
    Urban M, Rosen HR, Holbling N, et al. MR imaging for the preoperative planning of sphincter-saving surgery for tumors of the lower third of the rectum: use of intravenous and endorectal contrast materials. Radiology. 2000;214(2):503–8.PubMedGoogle Scholar
  32. 32.
    Beets-Tan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet. 2001;357(9255):497–504.PubMedGoogle Scholar
  33. 33.
    Guenaga KF, Matos D, Castro AA, Atallah AN, Wille-­Jorgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst. Rev. 2005;25(1):CD001544. Update 2009;(1):CD001544.Google Scholar
  34. 34.
    Jung B, Pahlman L, Nystrom P, Nilsson E. Multicentre ­randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg. 2007;94:689–95.PubMedGoogle Scholar
  35. 35.
    Contant CM, Hop WC, van’t Sant HP, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet. 2007;370:2112–7.PubMedGoogle Scholar
  36. 36.
    Pineda CE, Shelton AA, Hernandez-Boussard T, Morton JM, Welton ML. Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg. 2008;12(11):2037–44.PubMedGoogle Scholar
  37. 37.
    Solla JA, Rothenberger DA. Preoperative bowel preparation. A survey of colon and rectal surgeons. Dis Colon Rectum. 1990;33(2):154–9.PubMedGoogle Scholar
  38. 38.
    Morotomi M, Guillem JG, Pocsidio J, et al. Effect of polyethylene glycol-electrolyte lavage solution on intestinal microflora. Appl Environ Microbiol. 1989;55(4):1026–8.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Nichols RL, Broido P, Condon RE, et al. Effect of preoperative neomycin–erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Ann Surg. 1973;178(4):453–62.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer. 1975;36(6):2251–70.PubMedGoogle Scholar
  41. 41.
    Morson BC. Factors influencing the prognosis of early cancer of the rectum. Proc R Soc Med. 1966;59(7):607–8.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Morson B. President’s address. The polyp-cancer sequence in the large bowel. Proc R Soc Med. 1974;67(6):451–7.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Tierney RP, Ballantyne GH, Modlin IM. The adenoma to carcinoma sequence. Surg Gynecol Obstet. 1990;171(1):81–94.PubMedGoogle Scholar
  44. 44.
    Dukes CE. Simple tumors of the large intestine and their ­relationship to cancer. Br J Surg. 1925;13:720.Google Scholar
  45. 45.
    Helwig EB. The evolution of adenomas of the large intestine and their relationship to carcinoma. Surg Gynecol Obstet. 1947;84:36–49.PubMedGoogle Scholar
  46. 46.
    Jass JR. Do all colorectal carcinomas arise in preexisting ­adenomas? World J Surg. 1989;13(1):45–51.PubMedGoogle Scholar
  47. 47.
    Gabriel WB, Dukes CE, Bussey HJ. Lymphatic spread in ­cancer of the rectum. Br J Surg. 1935;25:395–413.Google Scholar
  48. 48.
    Corman ML. Principles of surgical technique in the treatment of carcinoma of the large bowel. World J Surg. 1991;15(5):592–6.PubMedGoogle Scholar
  49. 49.
    McArdle CS, Hole D. Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. BMJ. 1991;302(6791):1501–5.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Hodgson DC, Zhang W, Zaslavsky AM, et al. Relation of ­hospital volume to colostomy rates and survival for patients with rectal cancer. J Natl Cancer Inst. 2003;95(10):708–16.PubMedGoogle Scholar
  51. 51.
    Meyerhardt JA, Tepper JE, Niedzwiecki D, et al. Impact of hospital procedure volume on surgical operation and long-term outcomes in high-risk curatively resected rectal cancer: findings from the Intergroup 0114 Study. J Clin Oncol. 2004;22(1):166–74.PubMedGoogle Scholar
  52. 52.
    Heald RJ. The ‘Holy Plane’ of rectal surgery. J R Soc Med. 1988;81(9):503–8.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet. 1994;344(8924):707–11.PubMedGoogle Scholar
  54. 54.
    Havenga K, DeRuiter MC, Enker WE, Welvaart K. Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer. Br J Surg. 1996;83(3):384–8.PubMedGoogle Scholar
  55. 55.
    Cawthorn SJ, Parums DV, Gibbs NM, et al. Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet. 1990;335(8697):1055–9.PubMedGoogle Scholar
  56. 56.
    Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg. 1995;181(4):335–46.PubMedGoogle Scholar
  57. 57.
    Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med. 1991;324(11):709–15.PubMedGoogle Scholar
  58. 58.
    Heald RJ. Rectal cancer: anterior resection and local ­recurrence – a personal view. Perspect Colon Rectal Surg. 1988;1(2):1–26.Google Scholar
  59. 59.
    Masui H, Ike H, Yamaguchi S, et al. Male sexual function after autonomic nerve-preserving operation for rectal cancer. Dis Colon Rectum. 1996;39(10):1140–5.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345(9):638–46.PubMedGoogle Scholar
  61. 61.
    Nagtegaal ID, van de Velde CJ, van der Worp E, et al. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 2002;20(7):1729–34.PubMedGoogle Scholar
  62. 62.
    Grinnell RS. Distal intramural spread of carcinoma of the ­rectum and rectosigmoid. Surg Gynecol Obstet. 1954;99(4):421–30.PubMedGoogle Scholar
  63. 63.
    Black WA, Waugh JM. The intramural extension of carcinoma of the descending colon, sigmoid, and rectosigmoid: a pathologic study. Surg Gynecol Obstet. 1948;87:457.PubMedGoogle Scholar
  64. 64.
    Quer EA, Dahlin DC, Mayo CW. Retrograde intramural spread of carcinoma of the rectum and rectosigmoid: a microscopic study. Surg Gynecol Obstet. 1953;96(1):24–30.PubMedGoogle Scholar
  65. 65.
    Williams NS, Dixon MF, Johnston D. Reappraisal of the 5 ­centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients’ survival. Br J Surg. 1983;70(3):150–4.PubMedGoogle Scholar
  66. 66.
    Pollett WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg. 1983;198(2):159–63.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Goligher JC, Dukes CE, Bussey HJ. Local recurrences after sphincter saving excisions for carcinoma of the rectum and rectosigmoid. Br J Surg. 1951;39(155):199–211.PubMedGoogle Scholar
  68. 68.
    Dukes CE. The surgical pathology of rectal cancer. Proc R Soc Med. 1943;37:131.Google Scholar
  69. 69.
    Wolmark N, Fisher B, Wieand HS. The prognostic value of the modifications of the Dukes’ C class of colorectal cancer. An analysis of the NSABP clinical trials. Ann Surg. 1986;203(2):115–22.PubMedPubMedCentralGoogle Scholar
  70. 70.
    Nelson H, Petrelli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93(8):583–96.PubMedGoogle Scholar
  71. 71.
    Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet. 1986;2(8514):996–9.PubMedGoogle Scholar
  72. 72.
    Takahashi T, Ueno M, Azekura K, Ohta H. Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum. 2000;43(10 Suppl):S59–68. Review.PubMedGoogle Scholar
  73. 73.
    Kusters M, Beets GL, van de Velde CJ, Beets-Tan RG, Marijnen CA, Rutten HJ, et al. A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Ann Surg. 2009;249(2):229–35.PubMedGoogle Scholar
  74. 74.
    Akasu T, Sugihara K, Moriya Y. Male urinary and sexual functions after mesorectal excision alone or in combination with extended lateral pelvic lymph node dissection for rectal cancer. Ann Surg Oncol. 2009;16(10):2779–86.PubMedGoogle Scholar
  75. 75.
    Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA Cancer J Clin. 1971;21(6):361–4.PubMedGoogle Scholar
  76. 76.
    West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P. Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol. 2008;26(21):3517–22.PubMedGoogle Scholar
  77. 77.
    Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg. 2007;94(2):232–8.PubMedGoogle Scholar
  78. 78.
    Jones OM, Smeulders N, Wiseman O, Miller R. Lateral ligaments of the rectum: an anatomical study. Br J Surg. 1999;86(4):487–9.PubMedGoogle Scholar
  79. 79.
    Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di Carlo V. Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum. 2007;50(4):464–71.PubMedGoogle Scholar
  80. 80.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365(9472):1718–26.PubMedGoogle Scholar
  81. 81.
    Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, 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(21):3061–8.PubMedGoogle Scholar
  82. 82.
    Zhou ZG, Hu M, Li Y, Lei WZ, Yu YY, Cheng Z, et al. Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc. 2004;18(8):1211–5.PubMedGoogle Scholar
  83. 83.
    Rothenberger DA, Wong WD. Abdominoperineal resection for adenocarcinoma of the low rectum. World J Surg. 1992;16(3):478–85.PubMedGoogle Scholar
  84. 84.
    Wong CS, Stern H, Cummings BJ. Local excision and postoperative radiation therapy for rectal carcinoma. Int J Radiat Oncol Biol Phys. 1993;25(4):669–75.PubMedGoogle Scholar
  85. 85.
    Rosen L, Veidenheimer MC, Coller JA, Corman ML. Mortality, morbidity, and patterns of recurrence after abdominoperineal resection for cancer of the rectum. Dis Colon Rectum. 1982;25(3):202–8.PubMedGoogle Scholar
  86. 86.
    Pollard CW, Nivatvongs S, Rojanasakul A, Ilstrup DM. Carcinoma of the rectum. Profiles of intraoperative and early postoperative complications. Dis Colon Rectum. 1994;37(9):866–74.PubMedGoogle Scholar
  87. 87.
    Christian CK, Kwaan MR, Betensky RA, et al. Risk factors for perineal wound complications following abdominoperineal resection. Dis Colon Rectum. 2005;48(1):43–8.PubMedGoogle Scholar
  88. 88.
    Williams NS, Johnston D. The quality of life after rectal excision for low rectal cancer. Br J Surg. 1983;70(8):460–2.PubMedGoogle Scholar
  89. 89.
    Steele Jr GD, Herndon JE, Bleday R, et al. Sphincter-sparing treatment for distal rectal adenocarcinoma. Ann Surg Oncol. 1999;6(5):433–41.PubMedGoogle Scholar
  90. 90.
    Papillon J, Berard P. Endocavitary irradiation in the conservative treatment of adenocarcinoma of the low rectum. World J Surg. 1992;16(3):451–7.PubMedGoogle Scholar
  91. 91.
    Slanetz Jr CA, Herter FP, Grinnell RS. Anterior resection versus abdominoperineal resection for cancer of the rectum and rectosigmoid. An analysis of 524 cases. Am J Surg. 1972;123(1):110–7.PubMedGoogle Scholar
  92. 92.
    McDermott F, Hughes E, Pihl E, et al. Long term results of restorative resection and total excision for carcinoma of the middle third of the rectum. Surg Gynecol Obstet. 1982;154(6):833–7.PubMedGoogle Scholar
  93. 93.
    Jones PF, Thomson HJ. Long term results of a consistent ­policy of sphincter preservation in the treatment of carcinoma of the rectum. Br J Surg. 1982;69(10):564–8.PubMedGoogle Scholar
  94. 94.
    Manson PN, Corman ML, Coller JA, Veidenheimer MC. ­Anterior resection for adenocarcinoma. Lahey Clinic experience from 1963 through 1969. Am J Surg. 1976;131(4):434–41.PubMedGoogle Scholar
  95. 95.
    Strauss RJ, Friedman M, Platt N, Wise L. Surgical treatment of rectal carcinoma: results of anterior resection vs. abdominoperineal resection at a community hospital. Dis Colon Rectum. 1978;21(4):269–76.PubMedGoogle Scholar
  96. 96.
    Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.PubMedGoogle Scholar
  97. 97.
    Heberer G, Denecke H, Pratschke E, Teichmann R. Anterior and low anterior resection. World J Surg. 1982;6(5):517–24.PubMedGoogle Scholar
  98. 98.
    Localio SA, Eng K, Coppa GF. Abdominosacral resection for midrectal cancer. A fifteen-year experience. Ann Surg. 1983;198(3):320–4.PubMedPubMedCentralGoogle Scholar
  99. 99.
    Wilson SM, Beahrs OH. The curative treatment of carcinoma of the sigmoid, rectosigmoid, and rectum. Ann Surg. 1976;183(5):556–65.PubMedPubMedCentralGoogle Scholar
  100. 100.
    Heald RJ. Synchronous and metachronous carcinoma of the colon and rectum. Ann R Coll Surg Engl. 1990;72(3):172–4.PubMedPubMedCentralGoogle Scholar
  101. 101.
    Whelan RL, Wong WD, Goldberg SM, Rothenberger DA. Synchronous bowel anastomoses. Dis Colon Rectum. 1989;32(5):365–8.PubMedGoogle Scholar
  102. 102.
    Curley SA, Carlson GW, Shumate CR, et al. Extended resection for locally advanced colorectal carcinoma. Am J Surg. 1992;163(6):553–9.PubMedGoogle Scholar
  103. 103.
    Gall FP, Tonak J, Altendorf A. Multivisceral resections in ­colorectal cancer. Dis Colon Rectum. 1987;30(5):337–41.PubMedGoogle Scholar
  104. 104.
    Steele Jr G, Ravikumar TS. Resection of hepatic metastases from colorectal cancer. Biologic perspective. Ann Surg. 1989;210(2):127–38.PubMedPubMedCentralGoogle Scholar
  105. 105.
    Wanebo HJ, Gaker DL, Whitehill R, et al. Pelvic recurrence of rectal cancer. Options for curative resection. Ann Surg. 1987;205(5):482–95.PubMedPubMedCentralGoogle Scholar
  106. 106.
    Tjandra JJ, Kilkenny JW, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon ­Rectum. 2005;48:411–23.PubMedGoogle Scholar

Copyright information

© ASCRS (American Society of Colon and Rectal Surgeons) 2011

Authors and Affiliations

  • Ronald Bleday
    • 1
  • Nelya Brindzei
    • 1
  1. 1.Department of SurgeryBrigham and Women’s HospitalBostonUSA

Personalised recommendations