title: The influence of type of operation for distal rectal cancer: survival, outcomes, and recurrence.
abstract: 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.
authors.affiliation: Dept. of General Surgery, European Institute of Oncology, University of Milano, Italy. antonio.chiappa@unimi.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Chiappa
authors.forename: Roberto
authors.initials: R
authors.lastname: Biffi
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Zbar
authors.forename: Emilio
authors.initials: E
authors.lastname: Bertani
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Luca
authors.forename: Ugo
authors.initials: U
authors.lastname: Pace
authors.forename: Francesca
authors.initials: F
authors.lastname: Biella
authors.forename: Carmine
authors.initials: C
authors.lastname: Grassi
authors.forename: Giulia
authors.initials: G
authors.lastname: Zampino
authors.forename: Nicola
authors.initials: N
authors.lastname: Fazio
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Pruneri
authors.forename: Davide
authors.initials: D
authors.lastname: Poldi
authors.forename: Marco
authors.initials: M
authors.lastname: Venturino
authors.forename: Bruno
authors.initials: B
authors.lastname: Andreoni
mesh_terms: 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