Results of treatment of distal rectal carcinoma since the introduction of total mesorectal excision: A single unit experience, 1994-2003

Antonio A. Chiappa, Roberto Biffi, Andrew P. Zbar, Fabrizio Luca, Cristiano Crotti, Emilio Bertani, Francesca Biella, Giulia Zampino, Roberto Orecchia, Nicola Fazio, Marco Venturino, Cristiano Crosta, Gian Carlo Pruneri, Carmine Grassi, Bruno Andreoni

Research output: Contribution to journalArticlepeer-review

Abstract

Background and aims: This study reviewed the results of surgery for distal rectal cancer (where the tumour was within 6 cm of the anal verge) following the introduction of total mesorectal excision for rectal cancer in one institution. Patients and methods: One hundred and fifty-three patients who had undergone elective curative surgical resection of rectal cancer within 6 cm of the anal verge were included. The demographic, operative and follow-up data were collected retrospectively. Comparisons were made between patients who had different surgical procedures. Results: The overall operative mortality rate was nil, and the morbidity 41%. With a mean follow-up of 37 months (range 5-100 months), local recurrence occurred in 18 of the patients. The 5-year actuarial local recurrence rates for double-stapled anastomosis, low-strength anastomosis and abdominoperineal resection (APR) were 39, 17 and 11% respectively. The local recurrence rate was significantly higher for double-stapled low anterior resection than for the other types of operation (P =0.007). On multivariate analysis type of surgery (P =0.025) and tumour stage (P =0.043), were associated with local recurrence, but only stage was a significant prognosticator of overall survival (P =0.0006). Conclusion: With the practice of total mesorectal excision, APR was still necessary in 40% of patients with rectal cancer within 6 cm of the anal verge. The local recurrence rate was lower in patients treated with APR than in those with double-stapled low anterior resection; however, survival rates were similar in these two groups.

Original languageEnglish
Pages (from-to)221-230
Number of pages10
JournalInternational Journal of Colorectal Disease
Volume20
Issue number3
DOIs
Publication statusPublished - May 2005

Keywords

  • Rectal cancer
  • Recurrence
  • Surgery
  • Survival
  • Total mesorectal excision

ASJC Scopus subject areas

  • Gastroenterology

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