Rectal Reconstruction in Treating Patients Who Are Undergoing Surgery for Rectal Cancer

This is a randomized, multicenter study. Patients are stratified according to participating center, gender, distance of the distal tumor margin from the dentate line (> 5 cm vs ≤ 5 cm), age (< 70 vs ≥ 70), neoadjuvant chemoradiotherapy (yes vs no), and distant metastasis (M0 vs M1). Patients are randomized to 1 of 3 treatment arms.

• Histologically proven rectal adenocarcinoma or rectal adenoma with/without neoadjuvant radiochemotherapy
• Total mesorectal excision needed
• Age ≥ 18 years
• Clinically normal function of the sphincter muscles (no history of frequent fecal incontinence for liquid or solid stools)
• Any T, any N, any M or adenoma
• An R0-resection is expected (liver metastases planned to be simultaneously
• Written informed consent, signed and dated by the patient and the investigator
• Completed baseline quality of life questionnaire

Exclusion criteria

• Rectal tumor other than adenocarcinoma or adenoma
• Previous rectal cancer surgery, other than local excision within the last 2 months
• Histologically proven chronic inflammatory bowel disease
• Contraindications to any of the 3 surgical techniques
• BMI > 35
• Patients with psychiatric, addictive or any disorder that would prohibit the understanding and giving of informed consent, completing the QL questionnaires and/or following the structured interview
• Inability to read and understand any of the languages available on the QL questionnaires,and spoken during the interview (German, French, Italian)