Oncological outcome of ultra-low anterior resection with total mesorectal excision for carcinoma of the lower third of the rectum: Comparison of intrapelvic double-stapled anastomosis and transanal coloanal anastomosis.
OBJECTIVE
The purpose of this study was to determine whether the type of ultra-low anterior resection (intrapelvic double-stapled anastomosis or transanal hand-sewn coloanal anastomosis) with total mesorectal excision for primary adenocarcinoma of the lower third of the rectum affects survival and recurrence after curative surgery.


METHODS
This retrospective study included 112 patients who underwent curative surgery achieved by ultra-low anterior resection in combination with either intrapelvic anastomosis using a double-stapling technique (DST group; n=82) or transanal hand-sewn coloanal anastomosis (CAA group; n=30). Univariate and corrected (multivariate regression) analyses were used to evaluate data. Median follow-up was 51.2 months for patients alive at the conclusion of this study.


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. Tumor-related factors (stage or histologic grade) were significant predictors of oncological outcome.


CONCLUSIONS
The type of ultra-low anterior resection (DST or CAA) did not affect survival and recurrence after curative resection for carcinoma of the lower third of the rectum.
Nakagoe
Tohru
T
First Department of Surgery, Nagasaki University School of Medicine, Japan. nakagoe@net.nagasaki-u.ac.jp
Ishikawa
Hiroshi
H
Sawai
Terumitsu
T
Tsuji
Takashi
T
Takeshita
Hiroaki
H
Nanashima
Atsushi
A
Akamine
Shinji
S
Yamaguchi
Hiroyuki
H
Yasutake
Toru
T
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D017792:Surgical Stapling / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome