Abdominosacral amputation of the rectum for low rectal cancers: ten years of experience.

BACKGROUND: Abdominoperineal resection for rectal cancer is related to the high frequency of local recurrences, risk of inadvertent bowel perforation, and disease-positive tumor margin. An alternative technique to this procedure, however, is the abdominosacral amputation of the rectum (ASAR). The aim of this study was to report on the technique and share our experience of ASAR on the cohort of consecutively operated patients.
METHODS: In its anterior stage, ASAR follows the rules of total mesorectal excision. In its posterior part, the patient is positioned in a prone jackknife position and the coccyx and the last sacral vertebra (if necessary) are removed, enabling a sharp and directly visualized resection of the tumor and other structures critical to local recurrence. Between 1998 and 2007, a total of 210 low-rectal cancer patients were so treated at our clinic.
RESULTS: Bowel perforation occurred in 9 patients, the circumferential resection margin was positive in 16 patients, and 38 patients had local wound complications. Seven (4.4%) of 158 patients with 2-year follow-up developed local recurrence, whereas 5-year observed and relative survivals were 68.3% and 73.2%, respectively.
CONCLUSIONS: ASAR has a low risk of bowel perforation, circumferential resection margin involvement, and local wound complications. The local recurrence rate is lower and survival better than with conventional abdominoperineal resection.