While abdominoperineal resection with permanent colostomy has been the surgical benchmark in the treatment of distal rectal carcinoma, different approaches to treatment have been sought for decades to decrease the morbidity and mortality associated with radical surgical procedures for this disease. The advent of alternative methods of sphincter preservation that afford excellent functional results has led to a decline in the incidence of abdominoperineal resection. With appropriate patient selection, accurate preoperative staging data, and the selection of a surgical approach appropriate to the tumor stage, conservative surgical approaches now can be considered in the treatment of cancer at every level of the rectum.
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