Chapter 79 The Rectum

The rectum begins where the tinea coli of the sigmoid colon join to form a continuous outer longitudinal muscle layer at the level of the sacral promontory. The rectum follows the curve of the sacrum and ends at the anorectal junction. The embryological hindgut forms the upper rectum, while the lower rectum is derived from the cloaca and is surrounded by extraperitoneal connective tissue. The superior rectal artery is the direct continuation of the inferior mesenteric artery and is the main arterial supply of the rectum. The superior haemorrhoidal veins draining the upper half of the anal canal above the dentate line pass upwards to become the rectal veins; these unite to form the superior rectal vein, which later becomes the inferior mesenteric vein. This forms part of the portal venous system and ultimately drains into the splenic vein.

Multiple Choice Questions
Weblinks

Journal articles

https://ascopubs.org/doi/full/10.1200/JCO.2006.09.7840/ (paid)

This review article summarises the latest information about organ preservation for rectal cancer. Controversies around organ preservation and the expected outcomes are discussed along with the need for strict guidelines for patient selection.

https://www.sciencedirect.com/science/article/abs/pii/S0009926019301680?via%3Dihub/ (paid)

This review article discusses the rationale for magnetic resonance imaging (MRI) staging for advanced rectal cancer, including morphological and functional imaging. The clinical implications and future methods for improving MRI are discussed in relation to the latest TNM staging classification.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073406/ (free)

Cochrane review of different surgical approaches to treat full-thickness rectal prolapse. Includes analysis of 15 randomised controlled trials from 1007 participants. Surgical approaches included open and laparoscopic surgery, perineal and abdominal surgery, and rectopexy with or without resection. A conclusion about the best approach was hindered by the heterogeneity of the data and the lack of long-term follow-up.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4658624/ (free)

A systematic review of the evidence in support of transanal total mesorectal excision (TaTME) for rectal cancer, including 20 studies and 323 participants. TaTME was found to achieve better total mesorectal excision specimens with longer distal resection margins. Although TaTME was feasible in expert hands, the learning curve and safety profile were not well defined.

https://ales.amegroups.com/article/view/5613/html/ (free)

Review of robotic surgery for colorectal cancer. Robotic surgery achieves comparable short- and long-term oncological outcomes to laparoscopy with reduced rates of conversion to open surgery, but at an increased overall cost to the patient and healthcare system.

Guidelines

https://onlinelibrary.wiley.com/toc/14631318/2017/19/S1/ (free)

Guidelines on the management of cancers of the colon, rectum and anus as published by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) in 2017. This guidance provides comprehensive coverage of all aspects of cancer management, including diagnosis, surgery, multidisciplinary team working, pathology, outcomes and surveillance.

Databases

https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/ (free)

Cancer Research UK online database providing comprehensive reference to all colorectal cancer statistics. An invaluable resource of factual information about colorectal cancer in the UK.

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