Pyramidal Excision for Early Rectal Cancer and Special Closure Techniques

No other topic has had similar dramatic changes such as the therapy of low rectal cancer in the last two decades. The changes are not related only to the endoluminal technologies but mainly by the acceptance by colorectal surgeons that more aggressive surgery does not improve oncologic results in all stages of the disease. So colorectal surgeons are going through the same revolution that occurred in the 1980s for breast cancer. The locoregional resection of rectum and mesorectum, that we call “pyramidal excision” (PE), is the counterpart of the “lumpectomy” for breast cancer. After neoadjuvant therapy in T2-3 No tumors, the long-term results obtained by PE has shown the same oncological results of TME, but with the advantages, especially in the elderly patients, of no postoperative mortality or life-threatening complication. Postoperative morbidity is modest, and at six months no functional sequelae are reported.