Sphincter-Saving Operations for Cancer of the Rectum

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Abstract
EARLY attempts to cure rectal cancer were restricted to local removal by the perineal or sacral approach. In 1908, Ernest Miles described a radical operation for rectal cancer that encompassed all zones of lymphatic spread of the tumor.1 On the basis of pathological studies in patients who had died of rectal cancer, he recognized the need for an abdominal approach to control the upward spread of tumor through lymphatics running with the superior hemorrhoidal vessels. These patients had far advanced disease, with occlusion of proximal lymphatics and retrograde spread of tumor to the middle and inferior hemorrhoidal lymphatics. He therefore . . .