title: [Experience of ultralow anterior excision for rectal cancer: 508 cases analysis].
abstract: OBJECTIVE
  To investigate the operative techniques and postoperative effects of ultralow anterior excision for rectal cancer.
  
  
  METHODS
  From October 1996 to October 2006, 508 cases with rectal carcinoma at or below the peritoneal reflection with potential to preserve the anal function were divided into two groups. Of the patients, 365 cases underwent ultralow anterior excision and instrumental anastomosis, and 143 cases underwent manual colon-anal anastomosis (Parks operation).
  
  
  RESULTS
  In the group with anterior excision, the operations were all completed in the abdominal cavity, and avulsion of distal occlusive end occurred in 3 cases (0.9%), unsuccessful anastomosis happened in 2 cases (0.6%), unsatisfactory anastomosis with incomplete anastomosis circle turned out in 18 cases (5.6%). In the Parks operation group, the anastomosis was carried out manually at the anus and in abdominal cavity. Postoperative defecation function (times, soiling underwear, feeling of urgent defecation) in the group anterior excision was clearly better than that in the group of Parks operation (P < 0.05); difficulty of defecation (sense of residual stool, prolonging of defecation, cathartic usage) was also better in the group with anterior excision (P < 0.05). The anastomosis leakage rate was 3.5% in anterior excision group, compared to 5.6% in Parks operation group (P > 0.05). Anastomotic stenosis occurred in 77 cases (22.5%) in anterior excision group, and 40 cases (27.9%) in Parks operation group (P > 0.05). The local recurrence rate and 5-year survival rate were 11.8% and 68.8% in anterior excision group, and 10.1% and 66.8% in Parks operation group, respectively (P > 0.05).
  
  
  CONCLUSIONS
  Although there is no significant differences in local recurrence and 5-year survival rate between the two groups, the function and difficulty of defecation with instrumental anastomosis demonstrates clear advantages over Parks operation.
authors.affiliation: Department of General Surgery, Sichuan Cancer Hospital, Chengdu 610041, China.
authors.forename: Bao-shan
authors.initials: BS
authors.lastname: Liu
authors.forename: Lin
authors.initials: L
authors.lastname: Xu
authors.forename: Jin
authors.initials: J
authors.lastname: Yan
authors.forename: Chao
authors.initials: C
authors.lastname: Liu
authors.forename: Yang-chun
authors.initials: YC
authors.lastname: Zheng
mesh_terms: D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome