Rectal and Anal Cancers: Conservative Treatment by Irradiation -- An Alternative to Radical Surgery

Although attempts at radical removal of cancers of the rectum had been performed earlier, it was not until W. E. Miles in 1908 re- ported his experience in the management of cancer in this ana- tomic part, that the combined abdominoperineal resection be- came the recognized and accepted approach for the treatment of this cancer. Miles reasoned that proctectomy removed the cancer, bearing a segment oflarge bowel but also the regional lymphatics into which the cancer spread, not only proximally, but laterally and distally as well. In his monograph in 1926 he stated: . . . There are, I hold, two main principles to be observed in the surgical treatment of cancer of the rectum and indeed of all cancers wherever they are found, first, ope- ration should be based on a knowledge of the demonstrable facts of pathology, and, second, the most extensive operation possible in conformity with that knowl- edge should be performed on all patients no matter how small or early the local manifestation of the disease may seem to be . . . This philosophy was appropriate in his time but today, with increased knowledge regarding the biological behavior of cancer of the rectum, the recognition of the importance of the extent of the primary lesion and staging of cancer, and the availability of multiple modalities in the management of neoplastic disease, the philosophy has appropriately changed.