Morbidity and mortality following abdominoperineal resection for low rectal adenocarcinoma

Abstract

Background: Abdominoperineal resection (APR) has been the standard treatment of low rectal cancer, but it is associated with significant morbidity and mortality.

Aim: To analyze the morbidity and mortality rates associated with this surgical procedure performed at a tertiary-level cancer center.

Materials and methods: From 1995-1999, 137 patients with rectal cancer located between 0 and 8 cm from the anal verge underwent APR. Covariates were analyzed mean chi 2 and those favorable or adverse covariates affecting the perineal infection and recurrences were analyzed by logistic regression analysis.

Results: There were 78 males and 59 females, with a mean age of 57.4 +/- 14.6 years. Mean intraoperative hemorrhage was 739 +/- 547 mL; 51 (37.2%) patients received blood transfusion. Seventy-two patients received preoperative radiotherapy (PRT): 22, postoperative chemo-radiation therapy; 21, PRT + chemotherapy, and 22, APR only. Seventeen patients (12.4%) had major complications and 47 (34.3%) had minor complications. Twenty patients (14.6%) developed perineal wound infection. The main factors influencing these complications were administration of PRT +/- chemotherapy and age over 55 years. Operative mortality was 0.7%. Median follow-up was 32 months. Twelve patients (8.8%) had local recurrence and 35 (25.7%) had distant recurrence. Overall five-year survival was 75%.

Conclusions: APR is a surgical procedure associated with significant morbidity but low postoperative surgical mortality. The main cause of morbidity was perineal would infection influenced by administration of PRT +/- chemotherapy and age over 55 years. However, this treatment association is linked with low rate of local recurrence.