الفهرس 
Anatomy of the RectumOnly 14 pages are availabe for public view
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Abstract
World wide, the large bowel is the fourth commonest site of cancer after lung, stomach and breast and the fourth cause of cancer death after lung, stomach and liver cancer. Rectal cancer is a major health problem in US with estimated 40, 340 new cases diagnosed in 2005.
Genetic factor, life style, age, sex, diet, some medications, intestinal and extraintestinal conditions play an important role in the etiology of caner rectum.
CT, MRI, ERUS, sigmoidoscope, colonscope, PET and abdominal US, tumour markers are very important investigations in preoperative staging of cancer rectum and in decision making of cancer rectum management.
There are four goals in the treatment of a patient with rectal cancer 1- local control. 2-long term survival. 3- Preservation of anal sphincter, bladder and sexual function. 4- Maintenance and improvement in quality of life. These goals are best achieved through multi-modality approach delivered by multi–disciplinary team.
TME is the operation of choice either laparoscopic or abdominal in which we dissect in an areolar plane between visceral fascia that envelops the rectum and mesorectum and the parietal fascia overlying the pelvic wall structure. The end result of this procedure, when performed properly, is intact mesorectum containing the draining L N s of the rectum. This technique also facilitates pelvic autonomic nerve preservation. TME emphasizes achievement of negative CRM and DRM thus optimizing the oncologic outcome.
LTME offers several potential benefits over OTME such as earlier return of enteric function, shorter hospital stay, better cosmosis, shorter median follow up, less major complications, less blood loss but much operative time.
Total Mesorectal Excision combined with Autonomic Nerve Preservation offer a great advantage with regard to genitourinary functions of the patients, TME & ANP is now advocated for surgical treatment of cancer rectum because it reduces local recurrence rate to 4% to 9% and improves quality of life.
Nerve stimulating devices are useful tools to facilitate identification of pelvic autonomic nerves during TME and to objectively confirm never preservation.
It is now technically possible to remove rectal cancers that are extending into the anal canal while preserving the anal sphincter mechanism. Ultra-low colorectal and coloanal anastomosis, together with a colonic pouch or coloplsty, ensure acceptable function in many patients.
Pre-operative long course CRT is recommended for rectal carcinoma when there is concern that surgery alone may not be curative this results in down-staging of the tumour (up to complete regression of the tumour has been reported).
CRT is associated with increased probability of surgical resection, an increase in sphincter saving operations, improved local control and long term survival.
Postoperative early and regular follow up of patients after curative resection by tumor markers, imaging and lower endoscope are important to reach a high cure rates.