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Source created 2026-08-25 · updated 2026-08-25
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ASCRS Ch29 - Proctectomy for Rectal Cancer

Citation

Migaly J, Weiss EG. Proctectomy for Rectal Cancer. In: Steele SR, et al., eds. The ASCRS Textbook of Colon and Rectal Surgery, 4th ed. Springer; 2022. pp. 509–527 (book pagination; References end p. 527).

Scope

Twenty-ninth chapter of the ASCRS 4th-edition textbook (tenth of Part III, Colorectal Cancer) — the technique-focused companion to the staging/neoadjuvant-therapy chapters already ingested (Ch24, Ch26, Ch28). Covers rectal/mesorectal anatomy relevant to nerve-sparing TME, the priorities of proctectomy, preoperative bowel preparation, open/laparoscopic/robotic/transanal (taTME) low anterior resection technique, the full menu of low pelvic anastomosis/reservoir options, abdominoperineal resection (including the ELAPE/cylindrical variant and perineal reconstruction), low anterior resection syndrome (including a formal consensus definition and the LARS score), multivisceral/extended resections for locally advanced disease, oncologic outcomes, and multidisciplinary rectal cancer care.

Key content and reconciliation approach

This chapter substantially overlaps four existing pages, each enriched rather than duplicated:

  • Total Mesorectal Excision (TME) & Sphincter-Sparing Resection — the primary target. Substantially expanded with detailed rectal/mesorectal anatomy (arterial/venous supply, the formal "holy plane"/Denonvilliers'/Waldeyer's fascia anatomy, hypogastric/pelvic-splanchnic nerve course), historical background (Heald/Quirke/Martling), the three priorities of proctectomy, preoperative bowel-preparation evidence, detailed open/laparoscopic/robotic LAR technique, the five low-pelvic-anastomosis/reservoir configurations (straight stapled, handsewn coloanal, J-pouch, end-to-side/Baker, transverse coloplasty), taTME safety/oncologic-outcome data (the International taTME registry and an 11-study meta-analysis) — resolving this page's own previously-flagged open item, multivisceral/extended resections (a genuinely new topic), and modern oncologic-outcome data (worldwide local recurrence now 4–8%, ACOSOG Z6051/ALaCaRT non-inferiority results).
  • Abdominoperineal Resection (APR) — enriched with declining-frequency context, an explicit clarification that incontinence alone is not an APR indication, prone-position perineal-dissection technique detail, a large nationwide-database study of ELAPE vs. traditional APR (954 patients, found no benefit for non-circumferential tumors) that refines this page's existing "proposed solution" framing of cylindrical APR, and a new Reconstruction after APR section (flap options).
  • Low Anterior Resection Syndrome (LARS) — substantially expanded with the formal Delphi consensus definition (8 symptoms + 8 consequences) and the LARS score instrument — resolving this page's own previously-flagged "no specific LARS score/questionnaire detail" open item — plus a fuller treatment ladder including sacral nerve stimulation outcome data.
  • Anastomotic Construction — the low-pelvic-anastomosis/reservoir section gains concrete technique specifics (J-pouch dimensions, Baker/end-to-side configuration, coloplasty technique and its declining use) to complement its existing outcome-comparison data.
  • New source page (this page) documents citation and reconciliation approach.

Limitations

  • Textbook chapter, not primary literature — reproduced as described. Several cited studies (the VASQIP/NSQIP/Margolin bowel-prep studies, the International taTME registry, the 11-study taTME meta-analysis, the 954-patient ELAPE database study, ACOSOG Z6051, ALaCaRT, the SEER 372,130-patient analysis, the OSTRICH/NCDB consortium data) are not independently ingested from primary publications on this wiki.
  • The chapter's own "Multidisciplinary Rectal Cancer Care" section is explicit that US rectal cancer care remains substantially less regionalized/standardized than in Europe or Asia, and that CRM positivity rates in the US (17.2%, per one cited NCDB analysis) are roughly double those reported in Europe (per a separate cited comparison) — reported as-is, not independently verified.

Relevance

Substantially expands Total Mesorectal Excision (TME) & Sphincter-Sparing Resection (the primary target, including full anatomy and multivisceral-resection content that's genuinely new to the wiki), Abdominoperineal Resection (APR), Low Anterior Resection Syndrome (LARS) (resolving its own flagged open item), and Anastomotic Construction.