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Operative Technique
June 1999

Proctectomy and Coloanal Anastomosis for Rectal Cancer

Author Affiliations

From the Section of Colon and Rectal Surgery, Washington University School of Medicine, St Louis, Mo.

Arch Surg. 1999;134(6):670-677. doi:10.1001/archsurg.134.6.670

Fueled by a greater understanding of pelvic physiology along with an improved comprehension of rectal cancer spread, we are now able to offer most patients restoration of intestinal continuity following oncologic proctectomy. Coloanal or ultralow colorectal anastomosis can be performed in most patients with midrectal cancers, provided that anal sphincter function is not impaired preoperatively. Functional results may be improved by construction of a colonic pouch with pouch-anal anastomosis. Temporary fecal diversion, usually with a diverting loop ileostomy, may be prudent, especially in patients undergoing neoadjuvant chemoradiation.