The parasacral sphincter‐splitting approach to the rectum

The parasacral, in most instances sphincter‐splitting, approach to the lower rectum has been used in 79 instances with no operative mortality; 36 cases of low rectal cancer were the subject of this paper. In UICC stages Ia and Ib (limited to mucosa and submucosa) and stage‐II tumors, those of the T2N0 type (penetration of rectal musculature wall with no lymph node involvement), are good indications for this conservative surgery of very low rectal malignancies at any age; the stage of local lymph node invasion and the depth of rectal invasion require intraoperative histological evaluation. In more advanced tumor stages this approach should be considered only if abdominoperineal amputation is categorically refused or if the patient is at very high risk (e.g., in very old patients). The parasacral operation is surprisingly well tolerated, provided the 2–3‐hour procedure is carried out under optimal cardiorespiratory supervision and care.