Abstract
EXTIRPATION of the rectum with preservation of the anal sphincter is not a new approach to the treatment of rectal cancer. Prior to the turn of this century, several European surgeons * had performed operations designed both to eradicate the disease and also to leave the patient with normal sphincteric function. The high recurrence rates following these procedures (of which most were performed exclusively through the perineal route) led Miles7to his intensive investigations of the lymphatic spread of cancer of the rectum. As a result, he devised the combined abdominoperineal resection with permanent abdominal colostomy in an effort to deal with the superior, lateral, and inferior pathways of lymphatic spread. This operation has since been standard among many Anglo-American surgeons who have regarded it as the procedure of choice in the treatment of rectal carcinoma, regardless of the site or character of the neoplasm. In recent years, however, careful
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