title: Total rectal resection and complete mesorectum excision followed by coloendoanal anastomosis as the optimal treatment for low rectal cancer: the experience of the National Cancer Institute of Milano.
abstract: BACKGROUND
  At present, abdominoperineal resection remains the most diffuse method of treatment of very low rectal cancer. Today, we can avoid this method in some patients by using a sphincter-saving procedure.
  
  
  METHODS
  From March 1990 to January 1999, 273 consecutive total rectal resections and coloendoanal anastomoses were performed at our Institute; this study concerns 141 consecutive patients treated for a primary adenocarcinoma of the distal rectum, from 3.5 to 8 cm from the anal verge. Patient stratification, based on definitive pathological report, was 31 Dukes' stage A (T2N0), 44 stage B (T3N0), and 66 stage C (T2N+-T3N+).
  
  
  RESULTS
  Overall recurrence rate was 9.2%; postoperative morbidity attributable to the procedure was low. A perfect continence was documented in 61% of cases. The only pathological factor related to local recurrence rate is peritumoral lymphocytic reaction inside and around the tumor (P = .0005 and .031) independently from the number of metastatic lymph nodes, depth of fatty tissue infiltration, and lymphatic and venous neoplastic emboli. The minimum follow-up time is 12 months.
  
  
  CONCLUSIONS
  Our data, in accordance with other authors, seem to highlight the relevant role that a well-practiced surgery, together with accurate information on the spreading of this disease, has in achieving an optimal local control of cancer.
authors.affiliation: Colorectal Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Leo
authors.forename: F
authors.initials: F
authors.lastname: Belli
authors.forename: S
authors.initials: S
authors.lastname: Andreola
authors.forename: G
authors.initials: G
authors.lastname: Gallino
authors.forename: G
authors.initials: G
authors.lastname: Bonfanti
authors.forename: F
authors.initials: F
authors.lastname: Ferro
authors.forename: E
authors.initials: E
authors.lastname: Zingaro
authors.forename: G
authors.initials: G
authors.lastname: Sirizzotti
authors.forename: E
authors.initials: E
authors.lastname: Civelli
authors.forename: F
authors.initials: F
authors.lastname: Valvo
authors.forename: M
authors.initials: M
authors.lastname: Gios
authors.forename: C
authors.initials: C
authors.lastname: Brunelli
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery; D005240:Feasibility Studies; D006801:Humans; D007558:Italy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures