Diseases of the Colon & Rectum

, Volume 37, Supplement 2, pp S35–S41 | Cite as

Low rectal cancer—What is the choice?

  • G. Fegiz
  • M. Indinnimeo
  • P. Gozzo
  • E. Del Grande
  • S. Cataldi
  • S. Brozzetti
Original Contributions
  • 11 Downloads

Abstract

In patients operated on for low rectal cancer, the functional results, disease recurrence, and survival have been evaluated with respect to the type of surgery performed. Particular attention was paid to analysis of the pathologic aspects, considered in our opinion, as risk factors for recurrence. The investigation was carried out on 131 patients, of whom 70 received anterior resection, 55 abdominoperineal resection, and 6 local treatment. Abdominoperineal resection was carried out in more advanced disease. Postoperative mortality was 2.1 percent after anterior resection and 0 after abdominoperineal resection or local treatment. Follow-up, carried out in 96 patients (44 anterior resections, 46 abdominoperineal resections, and 6 local treatments), ranged from 12 to 84 (mean, 33.3) months. Recurrence rate was 53.3 percent after abdominoperineal resection and 28.9 percent after anterior resection. Recurrence appears not be related to the treatment performed, but rather depend on certain aspects of the neoplasm such as diameter exceeding 5 cm, extraparietal infiltration, lymphangitis, and tumor indifferentiation. We observed anastomotic recurrence in 28.6 percent of patients with a margin of less than 2 cm. An intensive follow-up scheme enabled us to recognize this type of recurrence early and to reoperate with radical intent. One year after anterior resection functional results were encouraging. No severe incontinence was reported. Local treatment was performed in carefully selected patients (T1, N0) and no cases of mortality or recurrence were observed.

Key words

Low rectal cancer Anterior resection Abdominoperineal resection Follow-up in rectal cancer Risk factors in rectal cancer Anal function after coloanal and low colorectal anastomosis 

References

  1. 1.
    Indinnimeo M, Gozzo P, Brozzetti S. Il follow-up. In: Fegiz G, Indinnimeo M, Gozzo P, eds. Il cancro del retto. Padova: “Piccin Editore,” 1992:413–29.Google Scholar
  2. 2.
    Kirwan WO, Rupert B, Turnbull B Jr, Fazio VW, Weakley FL. Pullthrough operation with delayed anastomosis for rectal cancer. Br J Surg 1978;65:695–8.PubMedGoogle Scholar
  3. 3.
    Hildebrandt U. Local curative treatment of rectal cancer. Int J Colorectal Dis 1991;6:74–6.PubMedGoogle Scholar
  4. 4.
    Stearns MW, Deddish MR. Five-year results of abdominopelvic lymph node dissection for carcinoma of the rectum. Dis Colon Rectum 1959;2:169–72.PubMedGoogle Scholar
  5. 5.
    Williams NS, Dixon MF, Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients' survival. Br J Surg 1983;70:150–4.PubMedGoogle Scholar
  6. 6.
    Pollen WJ, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg 1983;198:159–63.PubMedGoogle Scholar
  7. 7.
    McDermott FT, Hughes ES, Pihl E, Johnson WR, Price AB. Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg 1985;72:34–7.PubMedGoogle Scholar
  8. 8.
    Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986;1:1479–82.PubMedGoogle Scholar
  9. 9.
    Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Lancet 1986;2:996–9.PubMedGoogle Scholar
  10. 10.
    Cawthorn SJ, Parums DV, Gibbs NM,et al. Extent of lateral resection margin as prognostic factor after surgery for rectal cancer. Lancet 1990;335:1055–9.PubMedGoogle Scholar
  11. 11.
    Enker W, Philipshen SJ,et al. En bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancer. Ann Surg 1986;203:426–33.PubMedGoogle Scholar
  12. 12.
    Moriya Y, Hojo K, Sawada T, Koyama Y. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectm 1989;32:307–15.Google Scholar
  13. 13.
    Indinnimeo M, Gozzo P, Brozzetti S, Aurello P. Problemi di stadiazione nel cancro del retto. In: Fegiz G, Indinnimeo M, Gozzo P, eds. Il cancro del retto. Padova: “Piccin Editore,” 1992:175–85.Google Scholar
  14. 14.
    Elliot MS, Todd P, Nichols R. Radical restorative surgery for poorly differentiated tumors of the middle rectum. Br J Surg 1982;69:273–4.PubMedGoogle Scholar
  15. 15.
    Kodner IJ, Shemesh EI, Fry RD,et al. Preoperative irradiation for rectal cancer. Improved local control and long-term survival. Ann Surg 1989;209:194–9.PubMedGoogle Scholar
  16. 16.
    Gall FP, Hermanek P. Cancer of the rectum-local excision. Surg Clin North Am 1988;68:1353–65.PubMedGoogle Scholar
  17. 17.
    Glaser F, Schlag P, Herfarth Ch. Endorectal ultrasonography for the assessment of invasion of rectal tumours and lymph node involvement. Br J Surg 1990;77:883–7.PubMedGoogle Scholar
  18. 18.
    Beynon J, Foy DM, Roe AM, Temple LN, Mortensen NJ. Endoluminal ultrasound in the assessment of local invasion in rectal cancer. Br J Surg 1986;73:474–7.PubMedGoogle Scholar
  19. 19.
    Graham RA, Garnsey L, Jessup JM. Local excision of rectal carcinoma. Am J Surg 1990;160:306–12.PubMedGoogle Scholar
  20. 20.
    Grigg M, McDermott FT, Pihl EA, Hughes ES. Curative local excision in the treatment of carcinoma of the rectum. Dis Colon Rectum 1984;27:81–3.PubMedGoogle Scholar
  21. 21.
    Morson BC. Factors influencing the prognosis of early cancer of the rectum. J R Soc Med 1966;59:607–8.Google Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1994

Authors and Affiliations

  • G. Fegiz
    • 1
  • M. Indinnimeo
    • 1
  • P. Gozzo
    • 1
  • E. Del Grande
    • 1
  • S. Cataldi
    • 1
  • S. Brozzetti
    • 1
  1. 1.I Institute of Surgical ClinicUniversity “La Sapienza”RomeItaly

Personalised recommendations