[Role of abdominoperineal resection in the surgical treatment of cancer of the rectum].
The respective indications for abdomino-perineal amputation and colorectal resection are being debated, especially in the treatment of mid-rectal cancer. We report a series of 242 patients operated on for cancer of the rectum, including 200 who underwent tumor resection, which aimed to be curative in 162 cases. In the choice of intervention we took into account the possibility of keeping a distal margin of security of at least 2 cm when carrying out the resection. The size of the tumor, its staging and degree of differentiation did not influence our choice. Operative mortality was 9.8% for amputations and 5.3% for resection; deaths occurring in patients over 65 years and in only two cases for specific reasons. Local recurrence developed in 16.3% of amputations and in 12.5% of resections. For the mid-rectum these percentages were respectively 20 and 10.7%, though this difference may partially be explained by a greater number of patients with Dukes stage C, among the patients undergoing amputation. Five year survival was 56.8% for amputation and 63.2% for resection. We therefore feel that abdomino-perineal amputation does not produce a better tumor clearance than resection, and that it should currently only be proposed in cases where a resection with a satisfactory margin of security cannot be ensured.
Liguori
G
G
Clinique Chirurgicale de l'Université, Trieste, Italie.
De Manzini
N
N
Balani
A
A
Leggeri
A
A
D005500:Follow-Up Studies; D006801:Humans; D008722:Methods; D009364:Neoplasm Recurrence, Local; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*
La place de l'amputation abdomino-périnéale dans le traitement chirurgical des cancers du rectum.