Techniques in Coloproctology

, Volume 15, Supplement 1, pp 51–54 | Cite as

Changes in treatment of rectal cancer: increased use of low anterior resection

  • A. Mekras
  • A. Michalopoulos
  • V. N. Papadopoulos
  • D. Mekras
  • V. Kalles
  • I. Tzeveleki
  • G. Dabakis
  • S. Netta
  • G. Basdanis
Article

Abstract

Purpose

The most common surgical procedures for patients with rectal cancer are low anterior resection (LAR) or abdominoperineal excision (APE). The aim of the present study is to evaluate and report the changes in the incidence of LAR and APE in the surgical treatment of rectal cancer over the last 15 years in a single surgical department.

Methods

The patient sample consisted of 251 consecutive patients (mean age 65.17; age range 22–87) that underwent surgical treatment for rectal cancer in a single center from 1996 to 2010. This time frame was divided into three 5-year periods (1996–2000, 2001–2005 and 2006–2010). Patients were classified into one of the aforementioned groups, depending on the date of their treatment.

Results

In the first period (1996–2000), 71 patients were treated for rectal cancer. Among them, 32.4% (n = 23) underwent an abdominoperineal excision (APE) while 56.3% (n = 40) were treated with LAR. In the second period (2001–2005), included 102 patients, from which 29.4% (n = 30) received an APE and 60.8% (n = 62) underwent a LAR for their disease. In the final period (2006–2010), from the 78 patients, only 12.8% (n = 10) of them underwent APE, while 74.3% (n = 58) were treated with LAR. There was a statistically significant (chi-square test, P = 0.005) difference between the 3 periods of time concerning the performance of LAR and APE.

Conclusions

According to the results of the present study, the rates of APE seem to decrease during the last 15 years, while LAR is more widely used in the surgical treatment of rectal cancer.

Keywords

Low anterior resection Abdominoperineal excision Rectal cancer 

References

  1. 1.
    Jemal A, Siegel R, Ward E et al (2007) Cancer statistics, 2007. CA Cancer J Clin 57:43–66PubMedCrossRefGoogle Scholar
  2. 2.
    Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J (2007) Colon and Rectum. In: Sabiston Textbook of Surgery, 18th edn. Saunders, ElsevierGoogle Scholar
  3. 3.
    Miles WE (1971) A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA Cancer J Clin 21:361–364PubMedCrossRefGoogle Scholar
  4. 4.
    Lavery IC, Lopez-Kostner F, Pelley RJ et al (2000) Treatment of colon and rectal cancer. Surg Clin North Am 80:535–569PubMedCrossRefGoogle Scholar
  5. 5.
    Paty PB, Enker WE, Cohen AM et al (1994) Treatment of rectal cancer by low anterior resection with coloanal anastomosis. Ann Surg 219:365–373PubMedCrossRefGoogle Scholar
  6. 6.
    Schroen AT, Cress DR (2001) Use of surgical procedures and adjuvant therapy in rectal cancer treatment. A population-based study. Ann Surg 234:641–651PubMedCrossRefGoogle Scholar
  7. 7.
    Chiappa A, Biffi R, Zbar AP, Luca F, Crotti C, Bertani E et al (2005) Results of treatment of distal rectal carcinoma since the introduction of total mesorectal excision: a single unit experience, 1994–2003. Int J Colorectal Dis 20:221–230PubMedCrossRefGoogle Scholar
  8. 8.
    Law WL, Chu KW (2001) Impact of total mesorectal excision on the results of surgery of distal rectal cancer. Br J Surg 88:1607–1612PubMedCrossRefGoogle Scholar
  9. 9.
    Ridgway PF, Darzi A (2003) The role of total mesorectal excision in the management of rectal cancer. Cancer Control 10(3):205–211PubMedGoogle Scholar
  10. 10.
    Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg 60:613–616CrossRefGoogle Scholar
  11. 11.
    Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1(8496):1479–1482PubMedCrossRefGoogle Scholar
  12. 12.
    Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899PubMedCrossRefGoogle Scholar
  13. 13.
    Enker WE, Thaler HT, Cranor ML, Polyak T (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346PubMedGoogle Scholar
  14. 14.
    Arenas RB, Fichera A, Mhoon D, Michelassi F (1998) Total mesenteric excision in the surgical treatment of rectal cancer: a prospective study. Arch Surg 133:608–611PubMedCrossRefGoogle Scholar
  15. 15.
    Tekkis PP, Heriot AG, Smith J et al (2005) Comparison of circumferential margin involvement between restorative and nonrestorative resections for rectal cancer. Colorectal Dis 7:369–374PubMedCrossRefGoogle Scholar
  16. 16.
    Chambers WM, Mortensen NJ (2004) Postoperative leakage and abscess formation after colorectal surgery. Best Pract Res Clin Gastroenterol 18:865–880PubMedGoogle Scholar
  17. 17.
    Cornish J, Tilney H, Heriot A et al (2007) A meta-analysis of quality of life for abdominoperineal excision of rectum versus anterior resection for rectal cancer. Ann Surg Oncol 14:2056–2206PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • A. Mekras
    • 1
  • A. Michalopoulos
    • 1
  • V. N. Papadopoulos
    • 1
  • D. Mekras
    • 1
  • V. Kalles
    • 1
  • I. Tzeveleki
    • 1
  • G. Dabakis
    • 1
  • S. Netta
    • 1
  • G. Basdanis
    • 1
  1. 1.1st Propedeutic Surgical ClinicAristotle University of Thessaloniki, AHEPA General HospitalThessalonikiGreece

Personalised recommendations