Invagination Method with Diagonal Resection of the Anal Canal for Cancer of the Lower Rectum

Abstract

If the length of the remaining anal canal after surgery is not adequate, various problems with defecation can occur. With the purpose of preserving the anal canal as much as possible, a new attempt was made in patients with distal rectal cancer in whom the anal canal would be resected when the usual sphincter-sparing operation is applied. The novelty of this technique is that, when the invaginated technique of the Maunsell-Weir method is performed, the everted anal canal in the perineum is resected diagonally to permit preservation of a maximum length of the anal canal. Anastomoses with the diagonal rectal stump prohibit strictures, which frequently occur upon colo-anal anastomosis. Indications for this procedure include: the low region, at a distance less than 4 cm from the dentate line; less than T2 for mural stage, and less than one third the circumference for size. Four patients, in whom this technique was sequentially performed 3 years ago, were favorably reviewed according to various aspects such as tumor size, site, mural stage, lymph node metastasis, postoperative urination/defecation function, and stool soilage. We believe that this method should be the operation of choice in selected patients with low rectal cancer.