title: Anus-preserving rectectomy via telescopic colorectal mucosal anastomosis for low rectal cancer: experience from a Chinese cohort.
abstract: OBJECTIVE
  To investigate the safety and efficacy of anus-preserving rectectomy via telescopic colorectal mucosal anastomosis (TCMA) for low rectal cancer.
  
  
  METHODS
  From August 1993 to October 2012, 420 patients including 253 males and 167 females with low rectal cancer underwent transabdominal and transanal anterior resection, followed by TCMA. The distance between the anus and inferior margin of the tumor ranged from 5 to 7 cm, and was 5 cm in 6 patients, 6 cm in 127, and 7 cm in 287 patients. Tumor-node-metastasis staging showed that 136 patients had stage I, 252 had stage II and 32 had stage III. Fifty-six patients with T3 or over received preoperative neoadjuvant chemoradiotherapy.
  
  
  RESULTS
  The postoperative follow-up rate was 91.9% (386/420) with a median time of 6.4 years. All 420 patients underwent radical resection. No postoperative death occurred. Postoperative complications included anastomotic leakage in 13 (3.1%) patients and anastomotic stenosis in 7 (1.6%). The local recurrence rate after surgery was 6.2%, the hepatic metastasis rate was 13.2% and the pulmonary metastasis rate was 2.3%. The 5-year survival rate was 74.0% and the disease-free survival rate was 71.0%. Kirwan classification showed that continence was good in 94.4% of patients with stage I when scored 12 mo after resection.
  
  
  CONCLUSIONS
  TCMA for patients with low rectal cancer leads to better quality of life and satisfactory defecation function, and lowers anastomotic leakage occurrence, and might be one of the safe operative procedures in anus-preserving rectectomy.
authors.affiliation: Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China. lisybz@163.com
authors.forename: Shi-Yong
authors.initials: SY
authors.lastname: Li
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
authors.forename: Xue
authors.initials: X
authors.lastname: Bai
authors.forename: Fu-Yi
authors.initials: FY
authors.lastname: Zuo
authors.forename: Guang
authors.initials: G
authors.lastname: Chen
authors.forename: Jun-Feng
authors.initials: JF
authors.lastname: Du
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Wei
authors.forename: Wei
authors.initials: W
authors.lastname: Cui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000502:physiology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods*; D044466:Asian People; D015331:Cohort Studies; D003106:Colon / Q000502:physiology / Q000601:surgery; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology / Q000556:secondary; D008175:Lung Neoplasms / Q000453:epidemiology / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000502:physiology / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Abdominoperineal resection; Low rectal cancer; Reconstruction; Rectectomy; Telescopic colorectal mucosal anastomosis