For mid- to upper-rectal cancer, what is a common sphincter-preserving option if feasible?

For mid- to upper-rectal cancer, what is a common sphincter-preserving option if feasible?

• A. Abdominoperineal resection
• B. Transanal excision
• C. Proctocolectomy
• D. Low anterior resection with stapled colorectal anastomosis

Answer: (D)

For mid- to upper-rectal cancers, preserving the anal sphincter is often possible by removing the tumor-bearing rectal segment and reconnecting the colon to the remaining rectum. A low anterior resection with a stapled colorectal anastomosis does this by excising the affected portion and then creating a tension-free connection between the colon and the distal rectal stump, typically with a circular stapler. This approach relies on having enough distance from the anal verge to achieve clear margins and a functional, leak-free anastomosis, along with an adequate mesorectal excision. Other options would not preserve the sphincter: an abdominoperineal resection removes the rectum and anal sphincter, requiring a permanent stoma; transanal excision is limited to very small, superficial lesions; proctocolectomy removes both rectum and colon, not sphincter-sparing. Therefore, when feasible, the sphincter-preserving choice is low anterior resection with a stapled colorectal anastomosis.

For mid- to upper-rectal cancers, preserving the anal sphincter is often possible by removing the tumor-bearing rectal segment and reconnecting the colon to the remaining rectum. A low anterior resection with a stapled colorectal anastomosis does this by excising the affected portion and then creating a tension-free connection between the colon and the distal rectal stump, typically with a circular stapler. This approach relies on having enough distance from the anal verge to achieve clear margins and a functional, leak-free anastomosis, along with an adequate mesorectal excision.

Other options would not preserve the sphincter: an abdominoperineal resection removes the rectum and anal sphincter, requiring a permanent stoma; transanal excision is limited to very small, superficial lesions; proctocolectomy removes both rectum and colon, not sphincter-sparing. Therefore, when feasible, the sphincter-preserving choice is low anterior resection with a stapled colorectal anastomosis.