In 2005 NCCN clinical guideline in oncology of rectal cancer, it recommended four management principles of surgery. The surgeon should perform a rigid proctoscopy before initiating treatment, remove primary tumor with adequate margins, dissect draining lymphatics by total mesorectal excision, and restore organ integrity if possible. The principles of surgery has been updated four times until 2015. But it remained recommending that the surgeon should perform a rigid proctoscopy so that the surgeon can handle the size, the location and the region of the tumor and make the determination of an optimal treatment plan such as restoring anus or not. Throughout ten-year NCCN clinical guidelines, pursuing R0 resection and restoring organ integrity if possible are the basic principles for the surgical treatment of rectal cancer.
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