Skip to main content

Open Technique for Transanal Resection

  • 1957 Accesses


Tumors in the lower third of the rectum present unique challenges for the surgeon. Local excision has long been a technique used as an alternative to radical surgery for these low rectal polyps and tumors. Radical resection in this location often requires a low rectal or colo-anal anastomosis or even an abdominoperineal excision, procedures that carry significant morbidity and mortality. For that reason, local excision has always been an appealing alternative with lower morbidity and preservation of function. However, improved functional outcomes have to be balanced with proper oncologic outcomes.


  • Transanal
  • Rectal cancer
  • Local excision
  • Radical surgery
  • T1 tumor

This is a preview of subscription content, access via your institution.

Buying options

USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-1-4939-1893-5_26
  • Chapter length: 7 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
USD   99.00
Price excludes VAT (USA)
  • ISBN: 978-1-4939-1893-5
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   129.00
Price excludes VAT (USA)
Fig. 26.1
Fig. 26.2
Fig. 26.3
Fig. 26.4


  1. Classic articles in colonic and rectal surgery. Paul Kraske 1851–1930. Extirpation of high carcinomas of the large bowel. Dis Colon Rectum. 1984;27(7):499–503.

    Google Scholar 

  2. Hargrove 3rd WC, Gertner MH, Fitts Jr WT. The Kraske operation for carcinoma of the rectum. Surg Gynecol Obstet. 1979;148(6):931–3.

    PubMed  Google Scholar 

  3. Kilpatrick FR, Mason AY. Post-operative recto-prostatic fistula. Br J Urol. 1969;41(6):649–54.

    CAS  PubMed  CrossRef  Google Scholar 

  4. Christiansen J. Excision of mid-rectal lesions by the Kraske sacral approach. Br J Surg. 1980;67(9):651–2.

    CAS  PubMed  CrossRef  Google Scholar 

  5. Westbrook KC, Lang NP, Broadwater JR, Thompson BW. Posterior surgical approaches to the rectum. Ann Surg. 1982;195(6):677–85.

    CAS  PubMed Central  PubMed  CrossRef  Google Scholar 

  6. Beck DEASoC, Rectal S. The ASCRS textbook of colon and rectal surgery. New York: Springer; 2011.

    Google Scholar 

  7. Friel CM. Local excision of T1 rectal cancer: where are we now? Dis Colon Rectum. 2010;53(9):1231–3. doi:10.1007/DCR.0b013e3181e1a1ff.

    PubMed  CrossRef  Google Scholar 

  8. Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff RD, Rothenberger DA. Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg. 2000;231(3):345–51.

    CAS  PubMed Central  PubMed  CrossRef  Google Scholar 

  9. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum. 2000;43(8):1064–71; discussion 71–4.

    CAS  PubMed  CrossRef  Google Scholar 

  10. Nash GM, Weiser MR, Guillem JG, Temple LK, Shia J, Gonen M, et al. Long-term survival after transanal excision of T1 rectal cancer. Dis Colon Rectum. 2009;52(4):577–82. doi:10.1007/DCR.0b013e3181a0adbd.

    PubMed  CrossRef  Google Scholar 

  11. Gopaul D, Belliveau P, Vuong T, Trudel J, Vasilevsky CA, Corns R, et al. Outcome of local excision of rectal carcinoma. Dis Colon Rectum. 2004;47(11):1780–8.

    CAS  PubMed  CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to James Yoo M.D. .

Editor information

Editors and Affiliations

Key Operative Steps

Key Operative Steps

  1. 1.

    Bowel prep with Fleets enema.

  2. 2.

    Place patient in prone-jackknife position.

  3. 3.

    Perform perianal and pudendal nerve blocks.

  4. 4.

    Place retaining sutures, if necessary.

  5. 5.

    Insert retractor into anus. For deeper lesions, everting sutures may be used.

  6. 6.

    Mark 1-cm margins of resection around the tumor.

  7. 7.

    Perform full-thickness resection along the margins. Must visualize perirectal fat to confirm adequacy of resection.

  8. 8.

    Close the defect transversely using absorbable sutures.

Rights and permissions

Reprints and Permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Poylin, V., Yoo, J. (2015). Open Technique for Transanal Resection. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1892-8

  • Online ISBN: 978-1-4939-1893-5

  • eBook Packages: MedicineMedicine (R0)