Ⅳ期直肠癌的外科治疗及预后分析

目的 探讨Ⅳ期直肠癌患者原发病灶切除的价值和适应证.方法 回顾性分析1988年1月至2005年12月在外科治疗的118例Ⅳ期直肠癌患者的临床资料,将118例分为二组,手术切除原发病灶组(105例)和仅行造瘘术组(13例).采用Kaplan-Meier法进行生存分析,Log-rank检验进行统计学比较,应用Cox比例风险模型进行多因素分析. 结果 118例中105例行直肠原发病灶切除,同期行转移瘤切除16例;13例行造瘘术.手术切除原发病灶组总的5年生存率为8.5%.其中同期行转移瘤切除者5年生存率31.2%,行辅助化疗者5年生存率20%.手术切除原发病灶组与造瘘组中位生存期分别为15个月、13个月(X2=0.736,P=0.778).手术切除原发病灶组中转移灶切除和转移灶未切除中位生存期分别为20个月、14个月(X2=5.382,P:0.020).手术切除原发病灶加术后全身化疗为主者中位生存期为21个月.多因素分析显示原发肿瘤分化程度、肝转移瘤最大径和全身化疗是影响直肠原发肿瘤切除预后的最主要因素. 结论 对于Ⅳ期直肠癌能同时切除原发及转移病灶的患者,外科手术治疗可延长生存时间.     

直肠外翻技术在腹腔镜低位直肠手术中的应用

目的探讨直肠外翻技术在腹腔镜低位直肠手术中的安全性、可行性及操作要点。方法 2007年8月～2009年8月,对14例低位直肠病变[直肠癌7例（伴肝转移1例）,家族性腺瘤性息肉病4例,溃疡性结肠炎3例]施行直肠外翻技术联合腹腔镜手术,采用已击发的圆形端端吻合器来外翻直肠残端。14例均行一期吻合、预防性回肠造瘘。结果 14例均在腹腔镜辅助下完成,无中转开腹,无手术死亡病例。14例直肠残端均外翻成功。术后炎性肠梗阻1例,吻合口狭窄1例。7例直肠癌随访11～25个月（中位时间18个月）,未发现局部复发,术前合并肝转移者术后3个月再次出现肝脏新发病灶,其余6例未发现远处转移。7例非直肠癌术后随访9～33个月（中位时间19个月）,未见肠管新发病灶。所有病例术后排尿控制功能良好,造瘘还纳术后肛门控便、控气功能良好,男性病人未出现明显性功能障碍。结论直肠外翻技术联合腹腔镜手术在准确、安全切除病灶的前提下,既满足了微创的要求,又降低了手术费用;用已击发的圆形端端吻合器外翻直肠残端,简单且有效。     

Mason手术在中低位直肠肿瘤局部切除术中的应用价值

目的:探讨Mason手术在中低位直肠肿瘤局部切除术中的应用价值。方法:对1994年10月至2005年10月采用Ma-son手术作局部切除的42例中低位直肠肿瘤患者资料作回顾性分析。结果:42例中直肠腺瘤10例,直肠癌30例,直肠类癌2例,恶性肿瘤中Tis-T1期21例,T2-T3期11例,病理证实切缘无肿瘤残留。术后随访其中1例因肝转移死亡,1例因复发行Miles手术。结论:Mason手术可作为直肠中低位良性肿瘤以及Tis-T1期中低位直肠癌的首选术式,对于进展期直肠癌选施Mason手术后应辅以放疗。     

结直肠癌合并肠梗阻临床分析

目的分析结直肠癌合并肠梗阻的临床特点和探讨手术方法的选择。方法1996年2月～2004年2月共收治结直肠癌合并急性肠梗阻106例，其中右侧结肠35例，横结肠7例，左侧结肠43例，直肠21例；Dukes B期41例，C期46例，D期19例。根据患者不同情况分别行一期手术和分期手术。结果共发生吻合口漏8例：左侧结肠6例，直肠2例，均为一期手术。对其中4例行近端结肠造瘘，2例行Hartmann手术，2例经保守治愈。左侧结肠癌分期手术17例均于术后3个月左右关闭造瘘口。4例横结肠造瘘中1例行二期切除。直肠癌行结肠造瘘11例中8例行二期切除。全组死亡2例：1例术后并发多器官功能不全综合征(NODS)，另1例术后并发吻合口漏致中毒性休克。结论(1)结直肠癌合并肠梗阻临床特点是：①左侧结肠梗阻多见；②晚期病例多见；③老年患者多见。(2)外科治疗的原则是解除梗阻，尽量切除肿瘤。应根据患者的具体情况选择合适的手术方式，一期手术尤其是左侧结肠的适应证要严格掌握。     

直肠癌并急性肠梗阻急诊手术临床体会

目的总结急诊手术治疗直肠癌合并急性肠梗阻的临床体会。方法回顾性分析2014-01—2015-10间收治的27例直肠癌合并急性肠梗阻患者的临床资料。结果 27例患者中行Hartmann手术10例,Dixon手术9例,Miles手术5例,肿瘤近端肠管单纯造瘘3例。术后发生切口感染2例,吻合口瘘2例,1例肺部感染,并发症发生率为18.52%。造口的患者排便通畅,可自行护理,无死亡病例。住院时间为(23.58±13.75)d。结论急诊手术治疗直肠癌合并急性肠梗阻时应尽早手术解除梗阻、切除肿瘤,以挽救患者的生命。应根据患者的全身情况及肠管、肿瘤的局部情况选择合理的手术方法,以减少并发症发生率,改善患者的生活质量。     

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目的 探讨晚期直肠癌的外科治疗方法。方法 回顾性分析1994～1999年收治的55例晚期直肠癌的临床资料。结果 均为Dukes D期或肝转移病例。行Hartmann术式11例,单腔乙状结肠造口术13例,双腔乙状结肠造口11例,横结肠造口1例。肝转移癌切除7例。其中直肠上动脉置管化疗20例,肝动脉置管化疗12例。行Hartmann术式者3年生存率为27%(3/11),肝动脉置管化疗组和直肠上动脉置管化疗组平均生存期为14个月,未切除或示行肝动脉置管化疗的肝转移癌及非手术治疗组平均生存期10个月。结论 姑息性手术和乙状结肠造口术主要用于治疗晚期直肠癌,不能切除的原发灶或肝转移灶可选择肝动脉或直肠上动脉置管化疗。姑息性手术、乙状结肠造口术及肝动脉或直肠上动脉置管化疗可解除梗阻、缓解疼痛症状,并能提高生活质量,延长生存期。     

经骶尾途径手术治疗中下段直肠病变

经骶尾途径手术切除直肠病变后在直视下完成肠吻合术是一种较好的保肛手术．1994年9月至1996年7月共施行此类手术9例，其中直肠癌4例．直肠绒毛状腺瘤3例．直肠平滑肌肉瘤1例，直肠狭窄1例．结果：全部病例随访2个月至3年，1例直肠癌术后吻合口漏而改行Miles手，1例术后骶前感染而保守治愈．1例直肠癌术后15个月肿瘤盆腔复发而行乙状结肠造痿术．2例病人术后诉坐位时会阴部疼痛，所有病例大便控制功能良好，无肛门失禁．结论：该手术作为良性直肠中下段病变的首选手术，对于恶性病变．该手术与开腹手术相结合，是彻底切除肿瘤和低位吻合较为理想的手术方式．     

老年直肠癌患者的局部治疗(电凝法)

对70岁以上的直肠癌患者,手术切除和永久性结肠造瘘术已成为最常用的方法。某些作者推荐局部切除,但大多数仍采用根治性手术。本文作者应用局部电凝法治疗了6例平均年龄77岁的直肠腺癌患者。1例诊断时已有肝转移,术后9个月死亡;另1例于术后19个月需作结肠造瘘术。余4例已随访9月～3     

腹腔镜辅助结直肠癌根治术的近期疗效及并发症分析

目的探讨腹腔镜结直肠癌根治术的近期疗效及并发症。方法回顾性分析2012年7月至2014年6月,昆明市第一人民医院普外科施行的54例腹腔镜辅助结直肠癌根治术的临床资料。其中直肠癌行Dixon术27例,右半结肠切除术12例,Miles术8例,乙状结肠切除术4例,左半结肠切除术3例。结果除外2例中转开腹,其余52例均在腹腔镜辅助下顺利完成手术,无手术死亡病例;结肠癌切除包括肿块在内的11~26 cm肠管;直肠癌行Dixon术或Miles术时,下端切缘距肿瘤下缘1~3 cm,术中冰冻及术后病理证实所有标本残端均无肿瘤细胞残留、浸润。手术时间112~325 min,平均手术时间186 min;术中出血30~400 ml,平均术中出血120 ml;术后排气时间36~72 h,平均术后排气时间48 h;淋巴结清扫9~21枚,平均淋巴结清扫14.5枚。术后无出血、吻合口狭窄等并发症发生;2例会阴部切口感染,经过换药后痊愈;1例术后2 d因吻合口瘘再次开腹造瘘,1例造瘘口肠坏死回缩,5个月后经原造瘘口再次造瘘术;1例Dixon术后附加小肠造瘘口肠套叠麻醉后手法复位。术后住院时间9~28 d,平均术后住院时间15.2 d。术后电话随访至2015年3月。电话随访期内,死亡2例;局部复发2例;肝转移1例;1例再发肠梗阻行复发肿瘤切除,回肠造瘘;1例Miles术后闭孔内肌旁复发,再次经肛肿瘤切除术;其余均未发现转移、复发及切口种植。结论腹腔镜辅助结直肠癌根治术具有患者创伤小、出血少,操作安全、术后并发症少等优点,可取得与传统开腹手术媲美的治疗效果。     

结直肠肿瘤并急性肠梗阻的外科治疗

目的探讨结直肠癌并急性肠梗阻围手术期的处理方法。方法回顾性分析2006年6月至2011年6月收治的97例结直肠肿瘤致急性肠梗阻患者的临床资料。结果 97例均经手术治疗。右半结肠癌伴梗阻32例,其中30例行右半结肠一期切除,无吻合口漏发生,另2例癌肿不能切除行捷径手术;一期左半结肠切除肠吻合术15例,术后发生吻合口漏1例;Hartmann手术13例,术后恢复顺利,造口排便通畅,3～6个月后均进行了顺利关瘘手术;直肠癌Dixon手术27例,低位直肠癌行Miles术10例;行单纯肠造口6例。死亡1例。术后最常见的并发症为切口感染与肺部感染。结论对于结直肠癌并急性发肠梗阻,应根据患者的具体情况决定手术时机及手术方式,左半结肠癌合并肠梗阻可考虑一期切除吻合,但要注意吻合口漏。做好围手术期的处理是减少并发症、降低病死率的关键。     

Palliation for rectal cancer. Resection? Anastomosis?

There is no agreement regarding the proper management of patients with advanced carcinoma of the rectum. We performed a study to clarify whether palliative resection with or without primary anastomosis is worthwhile and safe. Among 679 patients managed for cancer of the rectum, 125 were considered incurable and underwent palliative procedures. High and low anterior resections were performed in nine and 57 cases, respectively, abdominoperineal resection in 26, Hartmann's procedure in three, simple diverting colostomy in 17, and transanal excision in 13. The overall postoperative mortality rate was 0.8%. Postoperative morbidity was 18% in abdominal operations and none in local excisions. Among patients treated by abdominal resections, only one required subsequent reoperation for colonic obstruction secondary to local recurrence. The median survival was 6.4 months for patients treated by diverting colostomy, 14.8 months for abdominally resected cases, and 14.7 months for transanal excisions. We conclude that palliative resection, often with primary anastomosis or local transanal excision, can be done safely in patients with incurable rectal cancer. We believe this approach improves the quality of the remaining life for these patients.     

Location of Rectal Cancer Within the Circumference of the Rectum Does Not Influence Lymph Node Status

Background Patients with rectal cancer are treated in multimodal concepts on the basis of their tumor stage. In the context of local excision, it is of major importance to assess the risk of lymph node metastases in patients with T1 or T2 tumors. To identify patients with an increased risk of lymph node metastases, the influence of the location of the tumor within the rectum (anterior, posterior, lateral) and of other variables on lymph node status was investigated. Methods All consecutive patients undergoing low anterior resection or abdominoperineal resection for primary rectal cancer between October 2001 and September 2003 were included. A multivariate analysis was performed focussing on tumor location and other variables as potential predictive factors for lymph node metastases. Results Of 148 included patients, 135 (91%) had an anterior and 13 (9%) an abdominoperineal resection. All patients routinely underwent total mesorectal excision. A statistically significant correlation with positive lymph node status was found for patients with lymphatic invasion (P < .0001), higher T stage (P < .0001), presence of distant metastases (M1) (P = .0003), and circular growth of the tumor (P = .003), but not for tumor location. Multivariate analysis confirmed that patients without lymphatic invasion (odds ratio, .1; 95% confidence interval, .02–.48; P = .006) and with a low T stage (odds ratio, .07; 95% confidence interval, .002–.9; P = .004) have a significantly lower risk for positive lymph nodes. Conclusions Location of rectal cancer (anterior, posterior, lateral) is not a good predictor for lymph node metastases.     

Total rectal resection,mesorectum excision,and coloendoanal anastomosis: A therapeutic option for the treatment of low rectal cancer

Background: There is recent and sporadic evidence indicating that patients with very low rectal cancer may be treated via a sphincter-saving procedure, obviating the need for abdominoperineal resection and definitive colostomy. This study confirms these findings. Methods: From March 1990 to October 1994, 79 patients affected with primary low rectal cancers were submitted for total rectal resection, mesorectum excision, and coloendoanal anastomosis. All lesions were located within 8 cm of the anal verge (within 6 cm in 64 cases). Results: Eight patients relapsed at the pelvic level, and one patient only at the paraanastomotic site. Postoperative morbidity attributable to the procedure was low. A perfect continence was documented in 66% of cases after colostomy closure, and many patients (63%) had one or two bowel movements a day. Sixty-two patients of this series are alive, 49 without actual evidence of disease. Follow-up ranged from 2 to 56 months (median 23). Conclusions: The clinical and pathological data derived from this study suggest that radical mesorectum excision more than a large clearance margin of resection remains the most important factor in reducing the incidence of local relapse after low rectal cancer surgery and that total rectal resection and coloendoanal anastomosis is a suitable and safe option to traditional, demolitive surgical techniques.Presented at the 48th Annual Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

Bladder-Sparing Extended Resection of Locally Advanced Rectal Cancer Involving the Prostate and Seminal Vesicles

Purpose Total pelvic exenteration (TPE) is the standard procedure for locally advanced rectal cancer involving the prostate and seminal vesicles. We evaluated the feasibility of bladder-sparing surgery as an alternative to TPE. Methods Eleven patients with advanced primary or recurrent rectal cancer involving the prostate or seminal vesicles, or both, underwent bladder-sparing extended colorectal resection with radical prostatectomy. The procedures performed were abdominoperineal resection (APR) with prostatectomy (n = 6), colorectal resection using intersphincteric resection combined with prostatectomy (n = 4), and abdominoperineal tumor resection with prostatectomy (n = 1). Local control and urinary and anal function were evaluated postoperatively. Results Cysto-urethral anastomosis (CUA) was performed in seven patients and catheter-cystostomy was performed in four patients. Coloanal or colo-anal canal anastomosis was also performed in four patients. There was no mortality, and the morbidity rate was 38%. All patients underwent complete resection with negative surgical margins. After a median follow-up period of 26 months there was no sign of local recurrence, and ten patients were alive without disease, although distant metastases were found in three patients. Five patients had satisfactory voiding function after CUA, and three had satisfactory evacuation after intersphincteric resection (ISR). Conclusion These bladder-sparing procedures allow conservative surgery to be performed in selected patients with advanced rectal cancer involving the prostate or seminal vesicles, without compromising local control.     

Perineal colostomy: an alternative to avoid permanent abdominal colostomy: operative technique,results and reflection

Background

The most common injury to indicate definitive stoma is rectal cancer. Despite advances in surgical treatment, the abdominoperineal resection is still the most effective operation in radical treatment of malignancies of the distal rectum invading the sphincter and anal canal. Even with all the effort that surgeons have to preserve anal sphincters, abdominoperineal amputation is still indicated, and a definitive abdominal colostomy is necessary. This surgery requires patients to live with a definitive abdominal colostomy, which is a condition that modify body image, is not without morbidity and has great impact on the quality of life.

Aim

To evaluate the technique of abdominoperineal amputation with perineal colostomy with irrigation as an alternative to permanent abdominal colostomy.

Method

Retrospective analysis of medical records of 55 patients underwent abdominoperineal resection of the rectum with perineal colostomy in the period 1989-2010.

Results

The mean age was 58 years, 40 % men and 60 % women. In 94.5% of patients the indication for surgery was for cancer of the rectum. In some patients were made three valves, other two valves and in the remaining no valve at all. Complications were: mucosal prolapse, necrosis of the lowered segment and stenosis.

Conclusion

The abdominoperineal amputation with perineal colostomy is a good therapeutic option in the armamentarium of the surgical treatment of rectal cancer.     

Rectum carcinoma. Optimizing therapy by deep resection or excision]

Abdominoperineal excision of the rectum has been the surgical treatment of choice for rectal cancer of the middle and lower third for decades. However, subsequent to technical developments, particularly stapling instruments, sphincter saving procedures such as low anterior or intersphincteric resection superseded abdominoperineal excision in the majority of tumors of the middle and even lower third of the rectum. Within the last seven years (1990-1997), 253 patients with distal rectal cancer underwent surgery--in 204 patients surgery was carried out for the cure of malignancy, whereas in 49 patients surgery was performed for palliation. In the meantime, the rate of abdominoperineal excision with permanent stoma was steadily decreased from 25% (1990-1993) to 9% (1994-1997). Concerning oncologic quality, sphincter saving resections showed evidence that cure rates (3- and 5-year survival) were not compromised by these techniques; conversely, sphincter saving resections offered oncologic cure rates superior to abdominoperineal excision of the rectum. Complete lymphadenectomy with high ligation of the inferior mesenteric artery and total mesorectal excision (TME) are fundamental components of this approach. Moreover, the adverse effects of a permanent colostomy and the consecutively diminished quality of life following abdominoperineal excision can be avoided in approximately 80% of cases. In conclusion, at present 80-85% of rectal carcinomas of the middle or lower third can be surgically treated by sphincter saving low resections without compromising oncologic radicality.     

经腹膜外造口对低位直肠癌患者术后旁疝及排便功能的研究

目的探讨经腹-会阴联合直肠癌根治术后腹膜内造口与腹膜外造口对行腹腔镜手术治疗患者并发症及人工肛门控制排便能力影响。 方法选取2013年4月至2016年4月,涟水县人民医院收治的43例低位直肠癌患者,依据临床处理方法将其分为经腹膜外造口患者为观察组（21例,失访1例）;经腹膜内造口患者为对照组（22例,失访2例）,对比2组患者造口并发症及术后排便能力的差距。 结果（1）造口并发症情况比较：造口旁疝,观察组0,对照组2例,差异有统计学意义（P<0.05）;造口水肿,观察组4例,对照组1例,差异有统计学意义（P<0.05）。（2）对患者人工肛门排便控制能力进行比较,随访6个月,差异无统计学意义（P>0.05）;随访1年,差异有统计学意义（P<0.05）。（3）对患者综合评价优良率进行比较,随访6个月,2组差异无统计学意义（P>0.05）;随访1年,观察组高于对照组,差异有统计学意义（P<0.05）。 结论经腹-会阴联合直肠癌根治术后采用经腹膜外造口方式能够有效降低旁疝发生率,能够更好的对排便能力进行控制。     

Radical resection of rectal cancer primary tumor provides effective local therapy in patients with stage IV disease

Background The optimal use of radical surgery to palliate primary rectal cancers presenting with synchronous distant metastases is poorly defined. We have reviewed stage IV rectal cancer patients to evaluate the effectiveness of radical surgery without radiation as local therapy. Methods Eighty stage IV patients with resectable primary rectal tumors treated with radical rectal surgery without radiotherapy were identified. Sixty-one (76%) patients received chemotherapy; response information was available for 34 patients. Results Radical resection was accomplished by low anterior resection (n=65), abdominoperineal resection (n=11), and Hartmann’s resection (n=4). Surgical complications were seen in 12 patients (15%), with 1 death and 4 reoperations. The local recurrence rate was 6% (n=5), with a median time to local recurrence of 14 months. Only one patient received pelvic radiotherapy as salvage treatment. One patient required subsequent diverting colostomy. Median survival was 25 months. On multivariate analysis, the extent of metastasis and response to chemotherapy were determinants of prolonged survival. Conclusions For patients who present with distant metastases and resectable primary rectal cancers, radical surgery without radiotherapy can provide durable local control with acceptable morbidity. The extent of metastatic disease and the response to chemotherapy are the major determinants of survival. Effective systemic chemotherapy should be given high priority in the treatment of stage IV rectal cancer.     

Malignant tumors of the rectum

The aim of surgery in the treatment of malignancies of the rectum is eradication of disease and restoration of the patient to a useful place in society. That this goal is not always achieved is demonstrated by the generally recognized over-all 5-year survival of no more than 45%. Improvement in cure rate rests largely upon early detection of localized disease and new modalities for treatment of disseminated disease, but it is essential to emphasize that an appreciation of current knowledge of anatomy, pathology and physiology and the application of current methods of surgery and rehabilitation will achieve maximum benefit for each patient.Abdominoperineal resection and anterior resection are well-established methods of treatment of carcinoma of the rectum. Study of the spread of cancer and the increasing experience with sphincter-saving operations indicate that sacrifice of the anus is not always essential for the cure of rectal cancer.Our recent experience in treatment of carcinoma of the rectum by abdominosacral, abdominoperineal and anterior resection has been reported.⁶⁵ Data on sex, age and associated risk and operative motality for this group of 229 patients, treated by one surgeon (SAL), in a 6-year period are summarized in Table 1. The preponderance of males in the abdominoperineal group is not surprising since selection was based on level of lesion, and the wider female pelvis allows sphincter-saving procedures at a lower level. The three groups were otherwise comparable. The status of patients in this series in whom operation was considered curative is recorded in Table 2. A follow-up of up to 8 years shows that survival following abdominosacral resection compares favorably with abdominoperineal and anterior resection. Death from recurrence is correlated, with stage of disease, not with level of lesion.Sphincter function following low anterior resection is essentially normal. Patients are continent of stool and flatus but, as alluded to in the section on continence, they initially experience a period of frequent small bowel movements due to loss of reservoir function. It is gratifying to note that functional results following abdominosacral resection differ only in degree from those observed following standard anterior resection. All patients were continent of stool and flatus from the outset and, after a somewhat longer period, some 12 weeks, of aberrant reservoir continence, all regained satisfactory function. This process of adaptation is facilitated by early institution of a diet high in fiber content and moisture, and encouragement of the patient to suppress the frequent urge to defecate. Patients in this series undergoing abdominosacral resection would under other circumstances have had abdominoperineal resection. A colostomy, even well constructed, properly managed and accepted by the patient, is at best a poor substitute for a functioning anal sphincter.Patients undergoing abdominoperineal resection with permanent sigmoid colostomy are visited by the enterostomal therapist preoperatively. Instruction in colostomy irrigation and management of colostomy appliances begins as soon as intestinal function returns. At discharge on the 14th to 21st postoperative day, patients are confident in colostomy care, and rehabilitation may be continued on an outpatient basis. In 2–3 months 75% of patients achieve sufficient reservoir continence and regularity to spend the day without a colostomy appliance.Unless a patient is moribund from metastatic disease or has serious contraindications to operation due to severe intercurrent illness, an attempt at removal of the lesion should be made in every case. Little can be done to alleviate the suffering due to pain, tenesmus, infection and discharge of blood and mucus from an unresected rectal cancer. Indeed, the apparently inoperable growth may appear fixed because of its bulk rather than by invasion, and the surgical effort is then rewarded by effective palliation or cure.     

Importance of rectal extirpation for the therapy concept of low rectal cancers]

INTRODUCTION: The main objective of surgery of rectal carcinomas is to avoid a permanent colostomy by sphincter-sparing surgical procedures. A variety of different abdominoperineal resection rates is described in the literature. MATERIAL/METHOD: The study was performed in 2000 within the framework of a multicentric study including 282 hospitals.The purpose of the study was to document the quality of diagnosis and therapy for colorectal carcinomas.A total of 9477 patients were included in this study: 3402 suffering from a rectal carcinoma and 6075 suffering from a colon carcinoma. RESULTS: A total of 866 abdominoperineal resections was performed. This corresponds to an abdominoperineal resection rate of 27.4%. In 30.4% of all men and in 23.0% of all women an abdominoperineal resection was performed.Of all tumor patients who underwent abdominoperineal resection, 8.3% had a pT4 carcinoma and 57.5% a pT3 carcinoma.Adapted to the localization of the tumor in the rectum, i.e., the distance of the aboral tumor margin to the anal verge, the following abdominoperineal resection rates were found: <4 cm from the anal verge 84.6%, 4-7.9 cm 43.9%, 8-11.9 cm 5.8%, and 12-16 cm 0.5%.Intraoperative complications occurred in 11.8%, specific postoperative complications in 33.1%, and general postoperative complications in 27.4% of the patients.The postoperative lethality was 2.8%. The mean postoperative hospital stay was 21.7 days.Logistic regression identified the body mass index, gender, the distance of the carcinoma from the anal verge, and the T category as independent factors influencing the abdominoperineal resection rate. DISCUSSION: Despite an overall decrease in use, abdominoperineal resection will continue to play an important role for the surgical treatment of low rectal cancers in routine clinical practice in Germany.It will remain an individual decision for each patient whether the tumor and the patient allow sphincter preservation or whether abdominoperineal resection seems to be necessary.According to the results of the present study,a general definition of an abdominoperineal resection rate in an unselected group of patients should be viewed critically.