Local Recurrence after Sphincter-Saving Procedures for Carcinoma of the Rectum--An Analysis of 141 Cases--

During the past 18 years, 141 patients with rectal carcinomaunderwent curative sphincter-saving procedures. Local recurrencesoccurred in 17 patients, a recurrence rate of 12%. No significantcorrelation between the recurrence rate and the site of tumoror nodal involvement was found. Laparotomies were performedin 14 of the 17 patients with local recurrence. Thirteen patientsunderwent abdominoperineal excision. In five of them, the recurrentgrowths were completely resected, and they were thought to havedeveloped at the previously established suture line, while inthe remaining eight cases the operation was considered palliative.As the result of pathological study of these resected specimens,it is possible to draw the following conclusions:

1. The length of the distal margin of the normal bowel should bemore than 4 cm in locally advanced cases.
2. In patients whosesecond operation was not curative the recurrencesdid not developin the rectal stump or in the levator muscle,but in the pelvicwall.
3. Local recurrence after sphincter-saving procedures couldbeeffectively avoided by adequate clearance of the pararectalsoft tissues which could contain viable cancer cells, includingthe lymphatics and vessels as well as the lymph nodes.
4. Aftera sphincter-saving operation, the patient must be examinedundera strict follow-up regimen, because curative resectionof localrecurrent tumors by abdominoperineal excision willbe made possibleby earlier detection of the recurrence.