Key Concepts

• Removal of the rectum and mesorectum should routinely be performed using sharp dissection in the plane surrounding the mesorectal fascia to ensure removal of all mesorectum at risk for nodal spread.
• The quality of the mesorectum should be graded and the non-peritonealized radial margin of resection inked so that the pathologist can measure circumferential margin status.
• Multidisciplinary decision-making regarding the use of neoadjuvant and/or adjuvant therapy improves outcomes in patients with rectal cancer.
• Functional derangements are common following restorative proctectomy. Minimizing these derangements should be kept in mind when choosing type of neorectal reservoir and/or whether to perform anastomosis. Patients suffering from anterior resection syndrome may benefit from ongoing support and counseling.
• Adherence to oncologic principles should be maintained when performing proctectomy using minimally invasive surgical techniques.
• Locally advanced rectal cancer extending into other organs requires expertise at dissection outside of the usual tissue planes. With proper planning and combined surgery with other specialties, patients may enjoy good long-term outcomes.
• Pelvic failure rates have improved significantly over the past several decades as a result of increased attention to detail during proctectomy and the increased use of neoadjuvant therapy.