Stapled low anterior resection vs total abdominoperineal excision for distal rectal carcinoma

In the surgical treatment of rectal carcinoma, a successful restorative resection has obvious advantages for the patient's quality of life as compared with abdomino-perineal excision and permanent colostomy. The development of mechanical devices has allowed surgeons to perform sphincter-saving procedures in patients with distal tumors of the rectum who would otherwise be advised to have a permanent colostomy; however, the enthusiasm for extending the scope of LAR could be tempered by the fear that such an operation does not provide as radical a removal of the malignancy as an APR, so affecting local recurrence and survival adversely. Recurrence and survival rates in 94 stapled low anterior resections for carcinoma of the distal rectum (4 to 11 cm from the anal verge) performed between 1978 and 1986 were compared with those obtained in a similar historical 'control' group of 82 patients undergone abdominoperineal resection between 1965-1977 before introduction of stapling devices. There were no statistically significant differences between low anterior resection and abdominoperineal resection with respect to local (10.6% vs 14.6%) and distant (14.8% vs 15.8%) recurrence, and overall five-year survival (72% vs 68%). Therefore the liberal use of sphincter-saving resection for distal rectal growths does not appear to carry an increased risk of recurrence nor an unfavorable prognosis compared with APR.