Surgical technique of intersphincteric resection

Sphincter saving surgery of rectal cancer has made an enormous progress over the last 50 years. Pioneers such as Hochenegg [1], Mandl [2], Finsterer [3], Dixon [4], Cutait [5], Bacon [6], Goligher [7], Parks [8], Nicholls [9], Heald [10] and many others have contributed in different ways to this development. The awareness that the lymphatic spread of this tumor occurs only in oral direction within the mesorectum and the local spread is only a few millimeters in distal direction opened the chance of sphincter salvage even in tumors close to the sphincter apparatus. Such tumors had been treated traditionally with abdominoperineal resection. But as long as the sphincter apparatus is not infiltrated by the tumor, there is no reason to remove the sphincter with all its unpleasant sequelae for the patient. Since we have nowadays excellent tools to exclude sphincter infiltration preoperatively we are able to plan these operations properly.