Cancer of the rectum continues to be a significant health problem
in industrialized co- tries around the world. Relative 5-year
survival rates in the USA for cancer of the rectum from 1995 to
2001 improved to 65%, a 15% improvement over 20 years (American
Cancer Society, 2007). The reasons for this dramatic improvement
include more accurate pr- perative staging, aggressive neoadjuvant
therapy and improved surgical technique as well as
specialty-trained surgeons. Despite advances in nonoperative
techniques of radiation therapy, chemotherapy and immunotherapy,
surgical extirpation continues to be the cornerstone of curative
treatment of this potentially lethal disease. Radical cancer
excision with total mesorectal excision has become the preferred
surgical procedure for even early-stage cancers of the rectum. Over
the past decade the enthusiasm for local excision (and other local
treatments) has given way to persuasive (predominantly
retrospective) evidence that the incidence of locoregional
recurrence due to unsuspected lymphatic metastases and positive
lateral margins is un- ceptably high even for stage T tumors.
Vigorous attempts to find characteristics of the 1 tumor that would
allow successful local treatments are ongoing.
General
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