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International Journal of Surgical Oncology
Volume 2012, Article ID 247107, 9 pages
http://dx.doi.org/10.1155/2012/247107
Review Article

Approach to Rectal Cancer Surgery

1Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
2St George Clinical School, Faculty of Medicine, UNSW, Sydney, NSW 2052, Australia
3Cancer Care Centre, Department of Medical Oncology, St George Hospital, Kogarah, NSW 2217, Australia

Received 15 April 2012; Accepted 3 May 2012

Academic Editor: Manousos-Georgios Pramateftakis

Copyright © 2012 Terence C. Chua et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Rectal cancer is a distinct subset of colorectal cancer where specialized disease-specific management of the primary tumor is required. There have been significant developments in rectal cancer surgery at all stages of disease in particular the introduction of local excision strategies for preinvasive and early cancers, standardized total mesorectal excision for resectable cancers incorporating preoperative short- or long-course chemoradiation to the multimodality sequencing of treatment. Laparoscopic surgery is also increasingly being adopted as the standard rectal cancer surgery approach following expertise of colorectal surgeons in minimally invasive surgery gained from laparoscopic colon resections. In locally advanced and metastatic disease, combining chemoradiation with radical surgery may achieve total eradication of disease and disease control in the pelvis. Evidence for resection of metastases to the liver and lung have been extensively reported in the literature. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases is showing promise in achieving locoregional control of peritoneal dissemination. This paper summarizes the recent developments in approaches to rectal cancer surgery at all these time points of the disease natural history.