Total rectal resection,mesorectum excision,and coloendoanal anastomosis: A therapeutic option for the treatment of low rectal cancer |
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Authors: | Dr Ermanno Leo MD Dr Filiberto Belli MD Salvatore Andreola MD Maria Teresa Baldini MD Gian Francesco Gallino MD Riccardo Giovanazzi MD Luigi Mascheroni MD Roberto Patuzzo MD Marco Vitellaro MD Cinzia Lavarino PhD Rosaria Bufalino |
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Institution: | (1) Division of Pathology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy;(2) Statistical Analysis and Informatic Laboratory of PRESTCO (Prevenzione e Studi Clinici in Oncologia), Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy;(3) Division of General Surgery B, Istituto Nazionale per lo Studio e la Cura dei Tumori, via G. Venezian, 1, 20133 Milan, Italy |
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Abstract: | 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. |
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Keywords: | Rectal tumor Coloanal anastomosis Rectum Rectal surgery |
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