The "tailored surgery", in the preservation of the anal sphincter in the tumor of the rectum

Indroduction: surgical radicality in rectal tumors is synonymous with local neoplasm control with increased survival. In the name of these objectives the quality of life has been sacrificed in the past, but with the evolution of surgical techniques and the greater knowledge of the mechanisms that regulate neoplastic disease, today we have arrived at a culture that places integrity in the foreground. and the psychophysical equilibrium as irremocratic elements in the complete realization of the present man. (Ferlay, et al., 2012; Smith et al., 2013; Brenner et al., 2012; Hewitson, et al., 2008,) Materials and methods: From January 2010 to December 2017 consulted the database of the AOU "G Rodolico" University of Catania Department of surgical and specialist medical sciences II 111 patients suffering from rectal neoplasia and undergoing surgery were treated. Surgical therapy implemented was a "tailored surgery", (treatment in relation to the stage) Stage 0 (carcinoma in situ) The treatment consisted of local resection to remove all the tumor. In cases of recovery, the patient must perform serious CHRONIC checks every 3 months in the first two years, Stage I (T1 / N0 / M0) local resection external radiotherapy with or without chemotherapy if the neoplasm resists treatment with external radiotherapy, radiotherapy was performed internal in case of failure we proceed to the abdominal-perineal resection sec. Miles Results: From the 111 patients underwent surgery. In 18 cases (17%) there was a complete histo logical response (pT0). In 95 patients (95.5%) an operation was performed with the preservation of the sphincter apparatus. Discussion: Only surgery in cancer has healing effect exclusively in the initial stages, historically the abdomino-perineal amputation sec. Miles was the choice therapy with survival of 50-70% at 5 years. Great progress has been made in the surgical treatment of ultra-low rectal tumors with a more widespread tendency to techniques to preserve the sphincter function avoiding the final ostomy packaging. Conclusion: The technical and scientific progress achieved in recent years has shown that neoadjuvant therapy offers the possibility of complete responses with total regression of the neoplasm with the aim of obtaining an effective cure of the disease without resorting to surgery. mesorectal excision have led some authors to question the routine use of RT in reference to the initial forms even if the RT Endocavitary used for tumors with a diameter of less than 3 cm has achieved successes around 95%.