Is it Time for the Introduction of Colostomy Free Survival in Rectal Cancer Patients

The rectum is considered the straight part of the bowel although it's not straight with at least three folds. Sometimes defi ned as the last 12 cm of the large bowel other consider it as the last 15 cm. Surgeons mark it starting at the anorectal ring, anatomist use the dentate line, more consensus and agreements is needed for the rectum as a structure. Also there is a lot of difference between the upper and lower part of the rectum, anatomically and embryologically. Differences between both can be easily recognized in treatment options, treatment results, and consequences of treatment as regard permanent colostomy and sphincter control. With the growing evidence of the watch and wait policy it may be worthy to start separating the upper rectum from its lower part, which may help to direct us to different treatment approaches and the introduction of colostomy free survival as one of the end treatment results. Hence our suggestion of the separation between the upper and lower rectum.