The surgery for rectal cancer is more challenging than the one for colon cancer. Particularly lower rectal cancer when cancer is close to the anus or anal sphincter. For patients who have rectal cancer in the lower part of the rectum, general surgeon often removes both the rectum and the anus. If the anus is removed, the patient typically needs a permanent colostomy, which collects stool in a bag that is attached to the abdominal wall.
For low rectal cancers, our colorectal surgeon/ Colo proctologist Prof. Art Hiranyakas, MD., PhD. at Bangkok – Phuket Colorectal Disease Institute, Bangkok Hospital Phuket can do the Sphincter – Sparring surgery also called Sphincter Saving Surgery or Preserving Sphincter Surgery that eliminates the need for a permanent colostomy. This procedure allows for complete removal of the tumor and “spares” the anal sphincter muscle.
Advantages of Sphincter –Sparing surgery / Sphincter Saving Surgery / Sphincter Preserving Surgery
1. Can be done by traditional open surgery or minimally invasive surgery
2. This surgery can remove diseased tissue in rectum and preserve the rings of muscles that help control the bowel movement
Patient who has rectal cancer next to the anal sphincters may require a trailer surgical plan in order to achieve both the complete removal of the cancer and anal sphincter preservation. The surgical treatment options for rectal cancer includes
- Transanal local excision (or trans-anal endoscopic microsurgery, TEMS/ Trans-anal Minimally Invasive Surgery, TAMIS)
- Low Anterior Resection (LAR)
- Ultralow anterior resection (with or without trans-anal total mesorectal excision, TaTME)
- Colo-anal Anastomosis (CAA)
Rectal Cancer Treatment and Management
Initial evaluation:
- Colonoscopy
- Biopsy
- Pathology Results
Metastatic evaluation:
- CT Scan
- CEA Level and Liver Function Test
- Endorectal Ultrasound or MRI
- PET CT Scan (if recommended)
Pre-surgical Evaluation:
- Digital Rectal Examination
- Rigid Proctoscopy
- Clinical decision making about primary or adjuvant chemotherapy or radiotherapy
Sources:
https://colorectaldiseaseinstitute.com/en/sphincter-saving-surgery/
https://www.ummhealth.org/umass-memorial-medical-center/services-treatments/surgery/services-we-provide/colon-and-rectal-surgery/sphincter-sparing-surgery
https://www.medscape.com/answers/281237-100564/what-are-the-sphincter-sparing-surgical-options-the-treatment-of-in-rectal-cancer
