Critical and challenging issues in the surgical management of low-lying rectal cancer

Aeris Jane D. Nacion, Youn Young Park, Seung Yoon Yang, Nam Kyu Kim

Research output: Contribution to journalReview articlepeer-review

6 Citations (Scopus)


Despite innovative advancements, the management of distally located rectal cancer (RC) remains a formidable endeavor. The critical location of the tumor predisposes it to a circumferential resection margin that tends to involve the sphincters and surrounding organs, pelvic lymph node metastasis, and anastomotic complications. In this regard, colorectal surgeons should be aware of issues beyond the performance of total mesorectal excision (TME). For decades, abdominoperineal resection had been the standard of care for low-lying RC; however, its association with high rates of tumor recurrence, tumor perforation, and poorer survival has stimulated the development of novel surgical techniques and modifications, such as extralevator abdominoperineal excision. Similarly, difficult dissections and poor visualization, especially in obese patients with low-lying tumors, have led to the development of transanal TME or the “bottom-to-up” approach. Additionally, while neoadjuvant chemoradiotherapy has allowed for the execution of more sphincter-saving procedures without oncologic compromise, functional outcomes remain an issue. Nevertheless, neoadjuvant treatment can lead to significant tumor regression and complete pathological response, permitting the utilization of organ-preserving strategies. At present, an East and West dualism pervades the management of lateral lymph node metastasis, thereby calling for a more global and united approach. Moreover, with the increasing importance of quality of life, a tailored, individualized treatment approach is of utmost importance when taking into account oncologic and anticipated functional outcomes.

Original languageEnglish
Pages (from-to)703-716
Number of pages14
JournalYonsei medical journal
Issue number6
Publication statusPublished - 2018 Aug

Bibliographical note

Publisher Copyright:
© Yonsei University College of Medicine 2018.

All Science Journal Classification (ASJC) codes

  • Medicine(all)


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