If no metastases are found, the patient is oriented to surgery which remains the only curative option.
Before undergoing surgery, the patient should have venous thromboembolism prophylaxis with anti-platelet therapy and antibiotic prophylaxis (single dose of antibiotics providing both aerobic and anaerobic cover given within 30 minutes of induction of anaesthesia).
A preoperative risk assessment should be performed according to the appropriate guidelines.
The safe margin between the lower end of the tumour and the rectal stump must be greater than or equal to 2 cms. An appropriate mesorectal excision, depending on the localization of the tumour, has an impact on the rate of local recurrences.
There is currently no indication for extensive pelvic nodal clearance.
Lymph nodes at the origin of feeding vessel should be identified for pathologic examination.
Lymph nodes outside the field of resection considered suspicious should be biopsied or removed.
Tumour tissue left behind indicate an incomplete (R2) resection. The surgery report must indicate if the resection was complete (R0 - R2).