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Scripta Scientifica Medica

Сфинктеросъхраняваща хирургия при рак на ректума: съвременни възможности, изисквания и ограничения

Д. Дамянов, E. Kостадинов


Despite the progress of surgical methods, technology and foremost of the medical oncology (neoadjuvant radiochemotherapy) 48% of the patients after curative surgical treatment end up with a permanent colostomy. The possibilities for sphincter-saving are higher in case of early diagnosis. Adequate sphincter-saving surgery can be performed only if the surgeon is well aware of the anorectal anatomy and adjacent proximal structures. The type of resection is defined not only by the preoperatively established tumour location, but also by the anatomical localization of the anastomosis. The optimal aims of the surgical treatment of rectal cancer are curative (radical) resection, preservation of the anal sphincters and of the sexual and urinary functions as well. Currently, total mesorectal excision (TME) as a sphincter-saving procedures and rectal amputation are the standard procedures for rectal cancer. It highly represents the method of coloanal anastomosis with a difference in the perianal phase. The authors originally use diluted solution of terlipressin (remestip) for better visualization and vasoconstriction. Others suggest application of lidocaine with adrenaline. The anastomosis is performed in analogical manner, including the anoderma, the internal anal sphincter and totally the colonic wall. The sphincter-saving surgery of the rectum has ever rising application. The development of the surgical methods, medical oncology and reanimation have allowed for sphincter-saving in more than 90% of the patients with comparable surgical and oncological results after rectal amputation. The functional results, quality of life and social adaptation are significantly improved.


rectal cancer; sphincter-saving surgery; total mesorectal excision; partial mesorectal excision; coloanal anastomosis; functional results

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About The Authors

Д. Дамянов
Клиника по хирургия, Клиничен център по гастроентерология УМБАЛ „Царица Йоанна-ИСУЛ` ЕАД, София

E. Kостадинов
Клиника по хирургия, Клиничен център по гастроентерология УМБАЛ `Царица Йоанна-ИСУЛ` ЕАД, София

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