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September 1948

EVALUATION OF CONSERVATIVE RESECTIONWith End to End Anastomosis for Carcinoma of the Rectum and Lower Sigmoid Colon

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Arch Surg. 1948;57(3):361-372. doi:10.1001/archsurg.1948.01240020367007

THIS PAPER is not a crusade for resection of the rectum with restoration of continuity. It is an honest endeavor to assess the place of conservative resection, if any, in the operative therapy of rectal carcinoma. Certain facts are presented, and certain conclusions are drawn. Facts cannot be questioned, but conclusions should be critically assessed.

There are two basic arguments against anterior resection with end to end anastomosis as a means of dealing with carcinomas of the rectosigmoid and upper part of the rectum. One might be termed anatomic: the question of the blood supply of the upper end of the rectal stump after division of the superior hemorrhoidal artery. It has been established beyond question that, if the resection is carried down to the level of the levator ani muscles, the rectum distal to this has a perfectly adequate blood supply apart from the superior hemorrhoidal artery. One cannot,

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