title: Changes in outcome with sphincter preserving surgery for rectal cancer in Korea, 1991-2000.
abstract: OBJECTIVE
  To report the clinical and oncological data of patients operated on for rectal cancers 3-5 cm from the AV over a 10 year period, including the Sphincter preservation (SP) rate.
  
  
  METHODS
  We reviewed medical records of 304 patients with rectal cancers 3-5 cm from the AV who underwent surgical resection from January 1991 through December 2000. The 10 years were divided into three periods based on the introduction of new surgical techniques, specifically, ultralow anterior resection (ULAR) with double stapling in March 1994 and ULAR with coloanal anastomosis in April 1997. The rates of SP, complications and patient survival during these periods were compared.
  
  
  RESULTS
  The SP rate increased significantly over the 10 years, from 16.4% in period I (January 1991-February 1994), to 53.0% in period II (March 1994-March 1997), to 86.5% in period III (April 1997-December 2000) (p<0.001). Over time, the age of the patients increased (p=0.004), the length of the distal resection margin became shorter (p=0.005), and the rate of lymph node metastasis increased (p=0.016). The factors significantly influencing SP were the period (p<0.001) and the distance from the AV (p<0.001). Over time, morbidity did not increase, and overall and disease free survival rates did not decrease. In contrast, the overall survival of N2 cases significantly increased over time (p=0.0492).
  
  
  CONCLUSIONS
  Over 10 years, the SP rate in rectal cancers 3-5 cm from the AV was significantly increased by the introduction of the double stapling and coloanal anastomosis techniques. These surgical methods, however, had no effect on morbidity, disease free survival and overall survival rates.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea.
authors.forename: S-B
authors.initials: SB
authors.lastname: Lim
authors.forename: S C
authors.initials: SC
authors.lastname: Heo
authors.forename: M R
authors.initials: MR
authors.lastname: Lee
authors.forename: S-B
authors.initials: SB
authors.lastname: Kang
authors.forename: Y J
authors.initials: YJ
authors.lastname: Park
authors.forename: K J
authors.initials: KJ
authors.lastname: Park
authors.forename: H S
authors.initials: HS
authors.lastname: Choi
authors.forename: S-Y
authors.initials: SY
authors.lastname: Jeong
authors.forename: J-G
authors.initials: JG
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008207:Lymphatic Metastasis; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013528:Surgical Staplers; D016019:Survival Analysis; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome