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Total rectal resection, mesorectum excision, and coloendoanal anastomosis: A therapeutic option for the treatment of low rectal cancer

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Abstract

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.

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References

  1. Williams NS. The rationale for preservations of the anal sphincter in patients with low rectal cancer.Br J Surg 1984;71:575–81.

    CAS  PubMed  Google Scholar 

  2. 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.

    CAS  PubMed  Google Scholar 

  3. Phillips RKS. Adequate distal margin of resection for adenocarcinoma of the rectum.World J Surg 1992;16:463–6.

    Article  CAS  PubMed  Google Scholar 

  4. Karanjia ND, Schache DJ, North WRS, Heald RJ. “Close shave” in anterior resection.Br J Surg 1990;77:510–2.

    CAS  PubMed  Google Scholar 

  5. Cohen MA, Minsky BD. A phase I trial of pre-operative radiation, proctectomy, and endoanal reconstruction.Arch Surg 1990;105:247–51.

    Google Scholar 

  6. De Cosse JJ. Sphincter-sparing surgery.Surgery 1991;110:457–8.

    Google Scholar 

  7. McAnena OJ, Heald RJ, Lockhart-Mummery HE. Operative and functional results of total mesorectal excision with ultra-low anterior resection in the management of carcinoma of the lower one-third of the rectum.Surg Gynecol Obstet 1990;170:517–21.

    CAS  PubMed  Google Scholar 

  8. Steele G Jr, Busse P, Huberman MS, et al. A pilot study of sphincter-sparing management of adenocarcinoma of the rectum.Arch Surg 1991;126:696–702.

    PubMed  Google Scholar 

  9. Heald RJ, Ryall RDH. Recurrence and survival after total mesorectal excision in rectal cancer.Lancet 1986;1:1479–82.

    CAS  PubMed  Google Scholar 

  10. MacFarlane J, Ryall R, Heald R. Mesorectal excision for rectal cancer.Lancet 1993;341:457–60.

    CAS  PubMed  Google Scholar 

  11. Chapuis PH, Dent OF, Newland RC, Bokey EL, Pheils MT. An evaluation of the American Joint Committee (pTNM) staging method for cancer of the colon and rectum.Dis Colon Rectum 1986;29:6–10.

    CAS  PubMed  Google Scholar 

  12. Kirwan WO, Rupert B, Turnbull B, Fazio VM, Weakley FL. Pullthrough operation with delayed anastomosis for rectal cancer.Br J Surg 1978;65:695–9.

    CAS  PubMed  Google Scholar 

  13. Parks AG, Percy JP. Resection and sutured colo-anal anastomosis for rectal carcinoma.Br J Surg 1982;69:301–4.

    CAS  PubMed  Google Scholar 

  14. Lazorthes F, Fages P, Chiotasso P, Bugart R. Synchronous abdominotransphincteric resection of low rectal cancer: a new technique for direct colo-anal anastomosis.Br J Surg 1986; 73:573–5.

    CAS  PubMed  Google Scholar 

  15. Parc R, Tiret E, Frileux P, Moszkowski E, Loygue J. Resection and coloanal anastomosis with colonic reservoir for rectal carcinoma.Br J Surg 1986;73:139–41.

    CAS  PubMed  Google Scholar 

  16. Huguet C, Harb J, Bona S. Coloanal anastomosis after resection of low rectal cancer in the elderly.World J Surg 1990;14:619–23.

    Article  CAS  PubMed  Google Scholar 

  17. Enker WE, Pilipshen SJ, Heilweil ML, et al. En bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancer.Ann Surg 1986;203:426–33.

    CAS  PubMed  Google Scholar 

  18. Moriya J, Hoyo K, Sawada T, Koyama Y. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection.Dis Colon Rectum 1989;32:307–15.

    CAS  PubMed  Google Scholar 

  19. Glass R, Ritchie J, Thompson H, Mann C. The results of surgical treatment of cancer of the rectum by radical resection and extended abdominoiliac lymphadenectomy.Br J Surg 1985;72:599–601.

    CAS  PubMed  Google Scholar 

  20. Herrera L, Justiniano J, Castillo N, Petrelli NJ, Stulc PJ, Mittelman A. Metastases in small lymph nodes from colon cancer.Arch Surg 1987;122:1253–6.

    Google Scholar 

  21. Hermanek P, Gield J, Dwork O. Two programmes for examination of regional lymph nodes in colorectal carcinoma with regard to the new pN classification.Pathol Res Pract 1989;185:867–73.

    CAS  PubMed  Google Scholar 

  22. Kotanagi H, Fukuoka T, Shibata Y, et al. The size of regional lymph nodes does not correlate with the presence or absence of metastases in lymph nodes in rectal cancer.J Surg Oncol 1993;54:252–4.

    CAS  PubMed  Google Scholar 

  23. Herrera L, Villareal JR. Incidence of metastases from rectal adenocarcinoma in small lymph nodes detected by a clearing technique.Dis Colon Rectum 1992;35:783–8.

    Article  CAS  PubMed  Google Scholar 

  24. McDermott FT, Hughes ESR, 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.

    CAS  PubMed  Google Scholar 

  25. Philips RKS, Hittinger R, Blesovsky L, Fry JS, Fielding LP. Local recurrence following “curative” surgery for large bowel cancer. II. The rectum and rectosigmoid.Br J Surg 1984;71:17–20.

    Google Scholar 

  26. Pollet WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of rectum.Ann Surg 1983;70:159–63.

    Google Scholar 

  27. McGregor JR, Galloway DJ, George WD. Intraluminal tumor cells and perianastomotic tumor growth in experimental colonic surgery.Eur J Surg Oncol 1992;18:368–72.

    CAS  PubMed  Google Scholar 

  28. McGregor JR, Galloway DJ, McCulloch P, George WD. Anastomotic suture materials and implantation metastasis: an experimental study.Br J Surg 1989;76:331–4.

    CAS  PubMed  Google Scholar 

  29. York-Mason A. Trans-sphincter surgery of the rectum.Prog Surg 1974;13:66–97.

    Google Scholar 

  30. Filipe MI. The value of a study of mucosubstances in rectal biopsies from patients with carcinoma of the rectum and lower sigmoid in the diagnosis of premalignant mucosa.J Clin Pathol 1972;25:123–8.

    CAS  PubMed  Google Scholar 

  31. Dawson PM, Habib NA, Rees HC, Williamson RCN, Wood CB. Influence of sialomucin at the resection margin on local tumor recurrence and survival of patients with colorectal cancer: a multivariate analysis.Br J Surg 1987;74:366–9.

    CAS  PubMed  Google Scholar 

  32. Dawson PM, Habib NA, Fane S, Rees HC, Wood CB, Allen-Mersh TG. Association between extent of colonic mucosal sialomucin change and subsequent local recurrence after curative excision of primary colorectal cancer.Br J Surg 1990;77:1279–83.

    CAS  PubMed  Google Scholar 

  33. Wolff BG. Lateral margins of resection in adenocarcinoma of the rectum.World J Surg 1992;16:467–9.

    Article  CAS  PubMed  Google Scholar 

  34. Chan KW, Boey J, Wong SKC. A method of reporting radial invasion and surgical clearance of rectal carcinoma.Histopathology 1985;9:1319.

    CAS  PubMed  Google Scholar 

  35. Knudsen JB, Nilsson T, Sprechler M, Johansen A, Christensen N. Venous and nerve invasion as prognostic factors in postoperative survival of patients with resectable cancer of the rectum.Dis Colon Rectum 1983;26:613–7.

    CAS  PubMed  Google Scholar 

  36. Shardey MM. Intraluminal vs extraluminal local recurrence of colo-rectal carcinoma absence of predisposing histological factors after the resection.ACA Suppl 1991;93:21–2.

    Google Scholar 

  37. Heald RJ, Karanijia ND. Results of radical surgery for rectal cancer.World J Surg 1992;16:848–57.

    Article  CAS  PubMed  Google Scholar 

  38. Huddy PJ, Husband EM, Look MG, Gibbs NM, Marks CG, Heald RJ. Lymph node metastases in early rectal cancer.Br J Surg 1993;80:1457–8.

    CAS  PubMed  Google Scholar 

  39. Parc R, Berger A, Tiret E, Frileux P, Nordlinger B, Hannoun L. Anastomose colo-anale avec reservoir dans le traitement du cancer du rectum.Ann Gastroenterol Hepatol (Paris) 1987;23:329–31.

    CAS  Google Scholar 

  40. Hautefeuille P, Valleur P, Perniceni Martin B, Galian A, Cherqui D, Hoang C. Functional and oncologic results after coloanal anastomosis for low rectal carcinoma.Ann Surg 1988;207:61–4.

    CAS  PubMed  Google Scholar 

  41. Parks AJ. Per-anal anastomosis.World J Surg 1982;6:531–8.

    Article  CAS  PubMed  Google Scholar 

  42. Nicholls RG, Lubowski DZ, Donaldson DR. A comparison of colonic reservoir and straight colo-anal anastomosis for low rectal cancer.Ann Surg 1988;207:61–4.

    Google Scholar 

  43. Drake DB, Pemberton JH, Beart RW Jr, Dozois RR, Wolff BG. Colo-anal anastomosis in the management of benign and malignant rectal disease.Ann Surg 1987;206:600–5.

    CAS  PubMed  Google Scholar 

  44. Enker WE, Stearns MW Jr, Janov AJ. Peranal coloanal anastomosis following low anterior resection for rectal carcinoma.Dis Colon Rectum 1985;28:576–81.

    CAS  PubMed  Google Scholar 

  45. Localio SA, Eng K, Coppa GF. Abdominosacral resection for midrectal cancer: a fifteen year experience.Ann Surg 1983;198:320–4.

    CAS  PubMed  Google Scholar 

  46. Turnbull RB, Cuthbertson AN. Abdominoperineal pull-through resection for cancer and for Hirschbrung's disease.Cleve Clin Q 1961;28:109–15.

    PubMed  Google Scholar 

  47. Cutait DE, Figlioni FJ. A new method of colorectal anastomosis in abdominoperineal resection.Dis Colon Rectum 1961:4:335–42.

    CAS  PubMed  Google Scholar 

  48. Mason AY. Surgical access to the rectum: a trans-sphincter exposure.Proc R Soc Med 1970;63(suppl):91–4.

    PubMed  Google Scholar 

  49. Berger A, Tiret E, Parc R, et al. Excision of the rectum with colic J pouch-anal anastomosis for adenocarcinoma of the low and mid rectum.World J Surg 1992;16:470–7.

    Article  CAS  PubMed  Google Scholar 

  50. Leo E, Belli F, Baldini MT, et al. Total rectal resection and colo-anal anastomosis with colonic reservoir for low rectal cancer.Int J Colorect Dis 1994;9:86.

    Article  Google Scholar 

  51. Philipshen SJ, Heilweil M, Quan SHO, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resection of rectal cancer.Cancer 1984;53:1354–62.

    Google Scholar 

  52. Moosa AR, Ree PC, Marks JE, Levin B, Platz CE, Skinner DB. Factors influencing local recurrency after abdominoperineal resection for cancer of the rectum and recto-sigmoid.Br J Surg 1975;62:727–30.

    Google Scholar 

  53. Michelassi F, Block GE, Vannucci I, Montag A, Chappel R. A 5- to 21-year follow-up and analysis of 250 patients with rectal adenocarcinoma.Ann Surg 1988;208:379–89.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pathology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

    Cinzia Lavarino PhD

  2. Statistical Analysis and Informatic Laboratory of PRESTCO (Prevenzione e Studi Clinici in Oncologia), Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

    Rosaria Bufalino

  3. Division of General Surgery B, Istituto Nazionale per lo Studio e la Cura dei Tumori, via G. Venezian, 1, 20133, Milan, Italy

    Ermanno Leo MD,  Filiberto Belli MD, Maria Teresa Baldini MD, Gian Francesco Gallino MD, Riccardo Giovanazzi MD, Luigi Mascheroni MD, Roberto Patuzzo MD & Marco Vitellaro MD

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  1. Ermanno Leo MD
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Leo, E., Belli, F., Andreola, S. et al. Total rectal resection, mesorectum excision, and coloendoanal anastomosis: A therapeutic option for the treatment of low rectal cancer. Annals of Surgical Oncology 3, 336–343 (1996). https://doi.org/10.1007/BF02305662

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  • DOI: https://doi.org/10.1007/BF02305662

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