Rectal resection for cancer

The rectum is the last part of the large intestine, just before the anus. Rectal resection (proctectomy) consists of removing the part of the rectum containing the tumour, together with the fatty envelope surrounding it and its lymph nodes (total mesorectal excision). It is the cornerstone of treatment for rectal cancer. The operation is performed laparoscopically or through open surgery, deep in the pelvis, with great precision to preserve the nerves that control the bladder and sexual function. The colon is then joined to the remaining rectum or directly to the anal canal, which allows the anus to be preserved in the great majority of cases. A temporary stoma often protects this join for a few weeks. When the tumour is very close to the anus, an abdominoperineal resection with a permanent stoma is sometimes necessary; this possibility is always discussed in advance. Treatment is decided at a multidisciplinary team meeting based on pelvic MRI, CT scan and colonoscopy. Radiotherapy and/or chemotherapy before surgery are frequently offered to shrink the tumour and reduce the risk of recurrence. At Clinique Pasteur Tunis, the care pathway combines on-site imaging, multidisciplinary discussion, surgery with intensive care available, stoma education by the nursing team, and follow-up with the surgeon and the oncologist.