During the preliminary investigations, the localisation was determined in terms of the distance from the sphincter muscle. This is usually performed by means of MRI (magnetic resonance imaging). Depending on the tumour stage, direct surgery or preliminary treatment is performed with radiation and / or chemotherapy. If the sphincter is infiltrated and no distance to the sphincter can be achieved even following pre-treatment, the removal of the entire rectum including the sphincter and the anus is recommended. This operation results in a permanent, artificial bowel outlet through the abdominal wall.
In all other cases, the rectum is removed up to just above the sphincter muscle, including the enveloping layer, where the lymph nodes and the supplying blood vessels are also located. The colon, which is located further above, is then connected to the remaining rectum. As the healing of this connection can be critical, an artificial anus is usually created to protect this intestinal connection. The artificial bowel outlet is repositioned after the bowel connection has healed or after chemotherapy if the chemotherapy is still pending. The further therapy is also determined in this case, within the framework of our interdisciplinary tumour board.