Preoperative assessment and strategies of surgical treatment for middle and low rectal cancer        FU Chuan-gang , WANG Hao. Department of Colorectal Surgery, Changhai Hospital, the Second Military Medical University  Shanghai 200433, China
Corresponding author:FU  Chuan-gang , E-mail: fugang416@126.com
Abstract    Although radical resection is the mainstay of treatment for middle and low rectal cancer, there have been substantial changes in the strategies of treatment in the last decade. Previously, the purpose of preoperative assessment was mainly qualitative, determining whether or not radical surgery or sphincter-preserving operations could be performed based on tumor localization and etiologic diagnosis. Nowadays, the preoperative diagnosis addresses selection of appropriate therapeutic strategies and surgical modalities according to different stages for the sake of offering the biggest benefits to patients. Local excision is usually selected for patients with T1N0M0 rectal cancer without adverse prognostic factors. Preoperative chemoradiation is recommended for patients with locally advanced rectal cancer (T3-4 and/or N1-2 stage without distant metastasis). For patients with distal pulmonary and hepatic metastasis, whether the primary lesion should be resected or not depends on the patient general condition. With the proper application of these strategies, the therapeutic outcome of middle and low rectal cancer has been improved markedly in the last decade. However, some new problems have also arisen out of utilization of the new techniques.