The value and significance of the limited barium enema examination following restorative resection for carcinoma of the rectum.

The results of limited barium enema examinations from a consecutive series of 143 patients who underwent restorative resections for carcinoma of the rectum were studied. An assessment was made of the value of the investigation both in terms of clinical management decisions and also to see whether radiologically detected anastomotic leakage was associated with a higher incidence of tumour recurrence. A study was also made of the incidence of leakage with respect to tumour size, length of the distal resection margin, Dukes' grading and histological differentiation. Results showed that there was a greater incidence of tumour recurrence following anastomoses which leaked, although due to small numbers the figures did not reach statistical significance. There was no relationship between tumour size, grade, differentiation, or length of the distal resection margin, and radiological leakage. We consider that the limited ten day barium enema examination does not contribute significantly to surgical management of these patients, except to define the extent of a leak and in the assessment of new anastomotic techniques. However, we suggest that a larger series may demonstrate a statistically significant increase in pelvic recurrence in patients who developed leakage from the anastomosis. This could dramatically alter the application of the postoperative limited barium enema.