The influence of type of operation for distal rectal cancer: survival, outcomes, and recurrence.
OBJECTIVE
This study analyzed the results of treatment of rectal cancer (tumor within 12 cm of the anal verge) with different techniques.


METHODS
Two hundred and sixty-four patients who had undergone elective curative surgical resection of rectal cancer within 12cm of the anal verge were evaluated. The operative data and follow-up data were collected prospectively. Comparisons were made between patients who had different surgical procedures.


RESULTS
The overall peroperative mortality rate was nil, and the morbidity 39.4%. Local recurrence occurred in 21 of the patients with a median follow-up of 34 months (range: 5-105 months). The 3-year actuarial local recurrence rates for double-stapled anastomosis, low straight anastomosis and APR were 25%, 6%, and 5%, respectively. The local recurrence rate was significantly higher for double-stapled low anterior resection than for the other types of operation (p = 0.013). On multivariate analysis reconstruction with Knight-Griffen anastomosis (p = 0.013) and tumor distance from the anal verge <6 cm (p = 0.001), were associated with local recurrence but only stage was a significant prognosticator of overall survival (p = 0.012).


CONCLUSIONS
Following total mesorectal excision, the local recurrence rate was higher in patients treated with double-stapled low anterior resection than in those with termino-terminal low anterior resection or APR; survival rates were similar in these groups.
Chiappa
Antonio
A
Dept. of General Surgery, European Institute of Oncology, University of Milano, Italy. antonio.chiappa@unimi.it
Biffi
Roberto
R
Zbar
Andrew P
AP
Bertani
Emilio
E
Luca
Fabrizio
F
Pace
Ugo
U
Biella
Francesca
F
Grassi
Carmine
C
Zampino
Giulia
G
Fazio
Nicola
N
Pruneri
Giancarlo
G
Poldi
Davide
D
Venturino
Marco
M
Andreoni
Bruno
B
D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016737:Proctocolectomy, Restorative; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery; D013528:Surgical Staplers; D015996:Survival Rate