Rectal cancer: the impact of a colorectal unit on the preservation of the anal sphincter.
BACKGROUND
Mid- and lower rectum cancer is a technical challenge to the surgeon aiming to preserve the anal sphincter. The choice between abdominoperineal resection and anterior resection is often related to surgical skills.


OBJECTIVE
To evaluate the role of a specialized colorectal unit in preserving the anal sphincter mechanism in the treatment of rectal cancer.


METHODS
Between 1991 and 1996, 75 patients with rectal cancer up to 12 cm from the anal verge were operated at the Sheba Medical Center. Among them, 21 patients (group 1) underwent surgery in the colorectal unit and 54 patients (group 2) in the other two surgical departments. All patients had a complete preoperative investigation and were followed for 12-90 months.


RESULTS
Background and tumor parameters were similar for both groups. In group 1, 20 patients (95%) had low anterior resection and 1 patient (5%) had abdominoperineal resection as compared to 20 patients (37%) and 34 patients (63%), respectively, in group 2 (P < 0.005). There was no statistical difference in the systemic recurrence rate. Local recurrence was more frequent in group 2 (P < 0.05).


CONCLUSIONS
Special training in colorectal surgery enables the surgeon, in keeping with the principles of oncologic surgery, to preserve the anal sphincter mechanism in most patients with adenocarcinoma located in the mid- and lower third of the rectum.
Heldenberg
Eitan
E
Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel.
Vishne
Tal H
TH
Onaka
Niko
N
Dreznik
Zeev
Z
D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008511:Medicine; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010348:Patient Care Team; D012004:Rectal Neoplasms / Q000601:surgery*; D013038:Specialization; D016896:Treatment Outcome