Comparison of Two Types of Surgery in Treating Patients With Rectal Cancer

OBJECTIVES: * Compare local and distant recurrences in patients with mid-rectal cancer treated with wide mesorectal surgical excision with straight colorectal anastomosis versus total mesorectal surgical excision with colonic J pouch coloanal anastomosis. * Compare the functional, physiological, and anatomical outcomes in these patients treated with these two surgical procedures. * Compare disease-free survival and overall survival in these patients treated with these two surgical procedures. OUTLINE: This is a randomized, multicenter study. Patients are stratified according to treatment center. Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients undergo surgical resection with a wide mesorectal excision followed by a straight colorectal anastomosis. * Arm II: Patients undergo surgical resection with a total mesorectal excision followed by a colonic J pouch coloanal anastomosis. Patients then receive a temporary ileostomy which is closed 6 weeks later. Patients are followed at 6 weeks, every 4-6 months for 2 years, every 6 months for 2 years, and then annually thereafter. PROJECTED ACCRUAL: A minimum of 800 patients (400 per arm) will be accrued for this study.