Anterior resection controls cancer of the rectum as well as abdominoperineal excision

Abstract

Objective: To evaluate our results of anterior resection and abdominoperineal (AP) excision for the treatment of rectal cancer in terms of survival and local recurrence, and to assess the importance of clinical anastomotic leaks in the development of local recurrence.

Design: Retrospective study.

Setting: University hospital, Finland.

Subjects: 199 patients who underwent elective and curative operations for rectal cancer during the period 1981-1990.

Interventions: 83 AP excisions and 116 anterior resections.

Main outcome measures: Five year survival and rate of local recurrence.

Results: The proportion of anterior resections increased (compared with AP excisions) significantly from 43% (40/94) in the period 1981-1985 to 72% (77/107) in the period 1986-1990, but five year survival did not change (71% and 68%, respectively). 81 patients (41%) developed recurrences, 56 (28%) of which were local and 40 (20%) were restricted to the pelvis. Local recurrence was significantly more common after AP excision (30/83, 36%) than after anterior resection (26/116, 22%, p < 0.05). Advanced stage (Dukes' C) was a risk factor for local recurrence, but not the distance of the tumour from the anal verge. There were no significant differences between AP excision and anterior resection in patients with tumours in the distal two thirds of the rectum in terms of local recurrence (30/82, 37% compared with 14/62, 23%) and estimated overall five year survival (52/82, 63%, compared with 43/62, 69%). The corresponding figures for each stage were stage A, 19/21 (90%) compared with 20/21 (95%); stage B, 23/34 (68%) compared with 21/24 (88%); and stage C, 10/27 (37%) compared with 5/16 (31%). There were no significant differences between patients who developed clinical leaks (6/19, 32%) and those who did not (20/97, 21%) by stage in proportion of patients free from local recurrence and survival at five years.

Conclusion: The significantly increased number of anterior resections compared with AP excisions of the rectumin did not compromise our results in terms of local recurrence and five year survival, but did reduce the number of permanent colostomies.