Mortality associated with elective resection of colorectal cancer with anastomosis is principally related to age, cardio-vascular disease and avoidable adverse events. A wide range of complications may follow this type of surgery, especially after extra peritoneal operations. A classification of anastomotic leaks is suggested to assist in comparisons of this complication which remains a significant concern following extra peritoneal anastomoses.

To discuss indications for local excision of adenocarcinoma of the low rectum, two different series of patients were analysed. Series I consisted of 60 patients treated by local excision from 1969 to 1985 in whom local recurrence developed. Series II consisted of 59 patients who underwent resection for non high grade tumors less than or equal to 3.5 cm from 1980 to 1990 in whom lymph node spread was studied. A distinction is made between tumors which are obvious cancers and malignant polyps, and the discussion of indications for local excision is orientated to the former. The results of local excision have been disappointing but a number of compromise selections for local excision have been necessary. Endorectal ultrasound has emerged as the most important method of assessing the depth of invasion of the tumor. Stratifying the depth of the tumor is at present the most important prognostic indicator for lymph node metastasis and local recurrence in non high grade tumors. If the muscle layer is invaded by tumor, local metastasis will occur in 17% of patients. It is likely that only tumors involving superficial layers of muscle are suitable for local excision, but this needs further study. Mucinous carcinomas and the presence of lymphatic invasion are contra-indications to local excision. The shape and size of tumors are not independent prognostic indicators. The techniques available for local excision alter the indications. Salvage operations for recurrence after local excision have proved disappointing.

It is essential that articles presenting local recurrence rates should include both local recurrence in isolation and that which occurs with distant metastases. Although total mesorectal excision for rectal cancer was not performed in this study, the local recurrence rate is not materially different from that in several articles where total mesorectal excision has been used. Whether the distal mesorectum needs to be pursued in mid-rectal cancer is not yet proven.

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Introduction from the Editor An international working party co‐ordinated by Dr Ann Lowry, University of Minnesota, was charged with the task of producing definitions of terms applicable to anorectal physiology and rectal cancer. The consensus achieved is published below and will simultaneously appear in Diseases of Colon and Rectum and in the Australian New Zealand Journal of Surgery. It is essential that there is uniformity in descriptions and it is hoped that the Statement will be generally adopted and become standard terminology.