Thesis (Ph.D.) - Cairo University - National Cancer Institute - Department of Oncology - Surgical

A new method of rectal resection through perineum is introduced. In recent years, sphincter preservation surgery has decreased the need for abdominoperineal resection. In this method in which anal anastomosis is performed with hand or stapler, the aim is to completely remove the tumor and to control the tumor locally. In lower rectal tumors; sphincter preservation is possible through performing preoperative chemo radiation and tumor resection. Preoperative chemo radiation is often associated with good response of tumor and the possibility of sphincter preservation is increased in these patients and then, in the surgery; tumor local control is well done and there is no need for abdominoperineal resection. The anterior perineal plane for ultralow anterior resection of the rectum (APPEAR) technique is a new method in the treatment of lower rectal cancer. In this method, in addition to sphincter preservation, local treatment of tumor is well done and the tumor is removed with definite margin free of the tumor. Using this method, surgeon removes the tumor under direct vision and anastomosis is completely controlled. APPEAR technique is an alternative technique for sphincter preservation in lower rectal cancer, which is performed by open surgery or laparoscopy. This technique can decrease the need to permanent ostomy; also, anastomosis is performed under direct vision. The other advantage of this method is for patients with large tumors of the lower rectum or for those with small pelvis in which the surgeon has vision limitations and this approach would provide surgeon with direct vision and suitable margins of the tumor

Issued also as CD