title: Survival and recurrence after a sphincter-saving resection and abdominoperineal resection for adenocarcinoma of the rectum at or below the peritoneal reflection: a multivariate analysis.
abstract: OBJECTIVE
  The purpose of this study was to determine whether the type of operation [sphincter-saving resection (SSR) or abdominoperineal resection (APR)] for primary adenocarcinoma of the rectum at or below the peritoneal reflection affects survival and recurrence after curative surgery.
  
  
  METHODS
  This retrospective study included 184 patients who underwent curative surgery achieved by the following two types of operation between 1989 and 1998: (1) SSR ( n = 116 patients) including a low anterior resection with either double-stapling technique ( n = 86) or transanal coloanal anastomosis ( n = 30); (2) APR ( n = 91). The outcome factors evaluated were survival and tumor recurrence. Both univariate and corrected (multivariate Cox's and logistic regression) analyses were used to evaluate the data. The median follow-up was 47.4 months for patients alive at study conclusion.
  
  
  RESULTS
  Disease-free and disease-specific survivals, and the frequency and location of recurrence after surgery did not differ between the two types of operations. Multivariate analyses showed that the type of operation was not a significant independent variable in predicting disease-free survival or in the development of both local and distant recurrences after surgery. In addition, tumor-related factors (stage or histologic grade) were significant predictors of the outcome after surgery.
  
  
  CONCLUSIONS
  The type of operation (SSR or APR) did not affect the survival or recurrence after a curative resection for adenocarcinoma of the rectum at or below the peritoneal reflection.
authors.affiliation: First Department of Surgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakagoe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Sawai
authors.forename: Takashi
authors.initials: T
authors.lastname: Tsuji
authors.forename: Kenji
authors.initials: K
authors.lastname: Tanaka
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Hidaka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamaguchi
authors.forename: Toru
authors.initials: T
authors.lastname: Yasutake
mesh_terms: D000005:Abdomen / Q000601:surgery; D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D010537:Peritoneum / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome