New perspective in the treatment of low rectal cancer: Total rectal resection and coloendoanal anastomosis

Ermanno Leo, Filiberto Belli, Maria Teresa Baldini, Marco Vitellaro, Luigi Mascheroni, Salvatore Andreola, Massimo Bellomi, Roberto Zucali

Research output: Contribution to journalArticle

Abstract

PURPOSE: Presently abdominoperineal resection still remains the most diffuse modality of treatment of low rectal cancer. However, a new surgical approach is now available to avoid such a demolitive surgery and a definitive colostomy. METHODS: From March 1990 to March 1993, 58 total rectal resections were performed in 55 patients affected with primary or recurring cancers of the low rectum. As a restorative procedure, a colic J-shaped pouch and a handsewn pouch-endoanal anastomosis was adopted. All of the primary lesions were within 7 cm of the anal verge; in 74 percent the distal tumor margin was located less than 6 cm from the cutaneous edge. RESULTS: Histologic clearance of the rectum cut edge was documented in all cases. Seven patients relapsed locally from 7 to 14 months after surgery and in 3 more cases distant metastases were documented. Postoperative morbidity is low. After colostomy closure in 78 percent of patients, perfect continence was achieved and in 74 percent less than two bowel movements a day were recorded. Fifty patients are presently alive, 46 without evidence of disease. The follow-up ranged from 2 to 37 (median, 13) months. CONCLUSION: This experience, along with data obtained from last year's literature, indicates that a conservative surgical procedure, such as total rectal resection and coloendoanal anastomosis, can be considered a feasible and radical option for treatment of low rectal cancer.

Original languageEnglish
JournalDiseases of the Colon and Rectum
Volume37
Issue number2 Supplement
DOIs
Publication statusPublished - Feb 1994

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Keywords

  • Coloanal anastomosis
  • Rectal cancer
  • Rectal surgery
  • Rectum

ASJC Scopus subject areas

  • Gastroenterology

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