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Controversial Issues in Management of Carcinoma of the Rectum

Jerome J. DeCosse, MD; George E. Block, MD; Edward S. R. Hughes, MD, MS; Stuart H. Q. Quan, MD; Malcolm C. Veidenheimer, MD
Arch Surg. 1977;112(5):558-563. doi:10.1001/archsurg.1977.01370050018003.
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DR DE COSSE: The treatment of carcinoma of the rectum generates a substantial amount of controversy that seems to center around the relative indications for abdominoperineal resection, posterior resection, pull-through operations, anterior resection, or electrocoagulation. To these options may be added the role of radiation therapy.

For the sake of focusing on these issues, we might first ask whether there is agreement on certain "accepted" principles in the treatment of these patients. These include:

  1. The importance of multiple biopsies and determination of mobility in the preoperative assessment of a rectal tumor.

  2. The value of accurate preoperative measurement of the tumor and its relationship to the dentate line.

  3. The importance of a barium enema examination to rule out multiple malignancies or colon polyps.

  4. Irrespective of the virtues of oral antibiotic therapy, a thorough preoperative mechanical cleansing of the colon.

Dr Block: While accepting the importance of multiple


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