BACKGROUND: There is recent and sporadic evidence indicating that patients with very low rectal cancer may be treated via a sphincter-saving procedure, obviating the need for abdominoperineal resection and definitive colostomy. This study confirms these findings. METHODS: From March 1990 to October 1994, 79 patients affected with primary low rectal cancers were submitted for total rectal resection, mesorectum excision, and coloendoanal anastomosis. All lesions were located within 8 cm of the anal verge (within 6 cm in 64 cases). RESULTS: Eight patients relapsed at the pelvic level, and one patient only at the paraanastomotic site. Postoperative morbidity attributable to the procedure was low. A perfect continence was documented in 66% of cases after colostomy closure, and many patients (63%) had one or two bowel movements a day. Sixty-two patients of this series are alive, 49 without actual evidence of disease. Follow-up ranged from 2 to 56 months (median 23). CONCLUSIONS: The clinical and pathological data derived from this study suggest that radical mesorectum excision more than a large clearance margin of resection remains the most important factor in reducing the incidence of local relapse after low rectal cancer surgery and that total rectal resection and coloendoanal anastomosis is a suitable and safe option to traditional, demolitive surgical techniques.
BACKGROUND: There is recent and sporadic evidence indicating that patients with very low rectal cancer may be treated via a sphincter-saving procedure, obviating the need for abdominoperineal resection and definitive colostomy. This study confirms these findings. METHODS: From March 1990 to October 1994, 79 patients affected with primary low rectal cancers were submitted for total rectal resection, mesorectum excision, and coloendoanal anastomosis. All lesions were located within 8 cm of the anal verge (within 6 cm in 64 cases). RESULTS: Eight patients relapsed at the pelvic level, and one patient only at the paraanastomotic site. Postoperative morbidity attributable to the procedure was low. A perfect continence was documented in 66% of cases after colostomy closure, and many patients (63%) had one or two bowel movements a day. Sixty-two patients of this series are alive, 49 without actual evidence of disease. Follow-up ranged from 2 to 56 months (median 23). CONCLUSIONS: The clinical and pathological data derived from this study suggest that radical mesorectum excision more than a large clearance margin of resection remains the most important factor in reducing the incidence of local relapse after low rectal cancer surgery and that total rectal resection and coloendoanal anastomosis is a suitable and safe option to traditional, demolitive surgical techniques.
Authors: A Berger; E Tiret; R Parc; P Frileux; L Hannoun; B Nordlinger; R Ratelle; R Simon Journal: World J Surg Date: 1992 May-Jun Impact factor: 3.352
Authors: E Leo; F Belli; M T Baldini; M Vitellaro; L Mascheroni; S Andreola; M Bellomi; G Rebuffoni; F Lombardi; R Audisio Journal: Int J Colorectal Dis Date: 1994-05 Impact factor: 2.571
Authors: Julio Garcia-Aguilar; Qian Shi; Charles R Thomas; Emily Chan; Peter Cataldo; Jorge Marcet; David Medich; Alessio Pigazzi; Samuel Oommen; Mitchell C Posner Journal: Ann Surg Oncol Date: 2011-07-14 Impact factor: 5.344
Authors: Julio Garcia-Aguilar; Zhenbin Chen; David D Smith; Wenyan Li; Robert D Madoff; Peter Cataldo; Jorge Marcet; Carlos Pastor Journal: Ann Surg Date: 2011-09 Impact factor: 12.969