LA PROCTECTOMIA RESTAURATIVA NELLA CHIRURGIA AVANZANTA DEL CANCRO DEL RETTO

From a pool of 457 patients affected by rectal cancer, operated by the same surgeon in ten years, the authors consider the group of 129 total restorative proctectomies (TRP) with colo-ano anastomoses (CAA), looking for the effects of global exeresis of the mesorectum on the prognosis. TRP was performed with curative intention (RO: 125). The CAA was mechanical, end-to-end type since 1989 and side-to-end type in the following years. Operative mortality (30 days) was 3 patients (2.3%); two of them died from anastomotic leakage. The main cause of mortality was the leakage (with clinical effects or radiological only) that, in total, was 16.2% (23.4% in the end-to-end group, 10% in the side-to-end group). The haemorrhages were 3,8%, the stenoses were 4.6%. Continence, clinically assessed, is complete in one year in 85% of the disease-free patients, and it is more rapid and complete in CAA mechanically side-to-end performed. We did a follow-up of all patients. The pelvic recurrence index after 18 months of follow-up is 8%. The global actuarial survival after 5 years is 79% with variations that go from 91% at stage 1 to 53,8% at stage IV. These results, in agreement with the more recent studies, confirm the importance of the global exeresis of mesorectum to improve the curative possibility in rectal cancer surgery.