Introduction: Rectal cancer is a major public health problem with severe implications in the economic and social sphere, the complex treatment, of which both surgical and medical, requires constant changes and improvements that have as major objective the preservation of the quality of life in optimal oncological conditions. In the complex oncological and surgical treatment of any type of cancer, organ preservation is a therapeutic success. For patients with rectal cancer located in a low position, it is obvious that anterior resection with preservation of the sphincter apparatus (SP), when feasible, results most often in better life quality and lower morbidity compared to secondary abdominal-perineal resection and it also does not compromise the oncological outcome. Material and method: In order to accomplish this analysis specialty literature was revised and articles published between 2005 and 2015 and relevant to the topic under discussion were studied.
Results: There are studies that provide encouraging information on obtaining better SP rates, depending on the preoperative protocol of radiation used: short or long, with without chemotherapy, with long short post therapeutic period until surgery. The role of perioperative radiation therapy for the treatment of resectable rectal cancer is obvious in what conerns the decrease of local relapses, compared to the radical surgical resections with no radiation. Adding radiotherapy leads to a significant improvement in local control, reduced toxicity, but failed to reduce overall mortality and to also increase the number of resections with SP.
Conclusions: Rectal cancer treatment still requires a multidisciplinary management that constantly adapts the multitude of therapeutic strategies to each case in particular. The neoadjuvant therapy is an indispensable part in the treatment algorithm and improved oncologic outcome should be the primary objective Under certain conditions it may facilitate the resection procedure with SP. Further studies are needed in order to evaluate the role of chemoradiotherapy (CRT) in “sphincter sparing surgery”, in the surgical treatment of rectal cancer.
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