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Sphincter preservation — A fascinating challenge in rectal carcinoma surgery

Die Sphinktererhaltung — ein faszinierender Wandel in der Chirurgie des Rektumkarzinoms

  • Themenschwerpunkt: „Rektumkarzinom — Sphinktererhaltung“
  • Published:
Acta chirurgica Austriaca Aims and scope Submit manuscript

Abstract

Background: In the last decades there has been an increasing trend toward sphincter preservation for rectal cancer. This paper analyses a uniformly operated patient collective with regard to complication, tumor recurrence and survival rates.

Methods: Between January 1984 and July 1993, 440 patients were operated for rectal cancer. In the upper rectal third sphincter preservation was possible in 100%, in the middle third in 97% and in the lower third in 46%.

Results: Tumor resection was possible in 98.9%, curative resection in 85.7% of the 440 surgically treated patients. Anastomotic leakage was observed in 10.5%, postoperative hospital mortality for curatively operated patients was 1.9%. The 5-year actuarial survival rates for tumor stages I to IV were 99%, 77%, 44% and 20% respectively. The local recurrence rate was 12.7%.

Conclusions: A high rate of sphincter preservation can be achieved without sacrificing low morbidity, mortality or recurrence rates. The surgical trend towards sphincter preservation in the middle and lower rectal thirds is due to the increased application of stapler devices and to the histopathological examination of the distal and lateral resections margins. The mesorectum is recognized as an important source of local tumor recurrence.

Zusammenfassung

Grundlagen: Die Sphinktererhaltung in der Chirurgie des Rektumkarzinoms hat in den letzten Jahrzehnten deutlich an Bedeutung gewonnen. Diese Arbeit analysiert ein sehr einheitliches Krankengut in bezug auf Komplikations-, Tumorrezidiv-und Überlebensraten.

Methodik: Zwischen Jänner 1984 und Juli 1993 wurden 440 Patienten mit einem Rektumkarzinom chirurgisch therapiert. Im oberen Rektumdrittel wurden 100% sphinktererhaltend operiert, im mittleren Drittel 97% und im unteren Drittel 46%.

Ergebnisse: In 98,9% konnte eine Tumorresektion, in 85,7% eine Kurativresektion durchgeführt werden. Die Anastomoseninsuffizienzrate betrug 10,5%, die postoperative Letalität für kurative Operationen 1,9%. Die nach der „actuarial method“ evaluierte 5-Jahres-Überlebensrate betrug für die Tumorstadium I bis IV 99%, 77%, 44% bzw. 20%. Die Lokalrezidivrate war 12,7%.

Schlußfolgerungen: Ein hoher Prozentsatz sphinktererhaltender Resektionen ist nicht zwangsläufig mit erhöhten Letalitäts-, Morbiditäts- oder Lokalrezidivraten verbunden. Der chirurgische Trend, im mittleren und unteren Rektumdrittel sphinktererhaltend zu operieren, wurde durch den Einsatz von Klammernahtgeräten sowie durch histopathologische Untersuchungen über die distalen und lateralen Resektionsränder ermöglicht. Bedeutungsvoll ist das Mesorektum als Quelle von Lokalrezidiven.

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References

  1. Dixon AR, Maxwell WA, Thornton-Holmes J: Carcinoma of the rectum: a 10-year experience. Br J Surg 1991;78:308–311.

    Article  CAS  PubMed  Google Scholar 

  2. Dukes CE: The spread cancer of the rectum. Br J Surg 1930;17:643–648.

    Article  Google Scholar 

  3. Fielding LP, Stewart-Brown S, Hittinger R, Blesowsky L: Covering Stoma for elective anterior resection of the rectum: An outmoded operation? Am J Surg 1984;147:524–530.

    Article  CAS  PubMed  Google Scholar 

  4. Goligher JC, Dukes CE, Bussey HJR: Local recurrence after sphincter saving excisions for carcinomas of the rectum and rectosigmoid. Br J Surg 1951;39:199–211.

    Article  CAS  PubMed  Google Scholar 

  5. Goligher JE: Use of the circular stapling devices for the construction of the anastomosis in abdomino-transanal resection. Br J Surg 1979;66:501–504.

    Article  CAS  PubMed  Google Scholar 

  6. Heald RJ, Ryall RD: Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986;28:1479–1482.

    Article  Google Scholar 

  7. Heald RJ, Leicester RJ: The low stapled anastomosis. Dis Colon Rectum 1981;24:437–444.

    Article  CAS  PubMed  Google Scholar 

  8. Heald RJ: The “Holy Plane” of rectal surgery. J Roy Soc Med 1988;81:503–508.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Hermanek P, Karrer K: Synopsis colorektaler Tumoren. München, Pharmazeutische Verlagsgesellschaft München, 1983.

    Google Scholar 

  10. Hermanek P, Sobin LH: UICC-TNM Classification of malignant tumours. 4. Aufl. Berlin-Heidelberg-New York, Springer, 1992.

    Google Scholar 

  11. Hojo K, Koyama Y: The effectiveness of wide anatomical resection and radical lymphadenectomy for patients with rectal cancer. Jpn J Surg 1982;12:111–116.

    Article  CAS  PubMed  Google Scholar 

  12. Jatzko G, Schlapper D: Die Kathetercolostomie bei linksseitigen Kolonresektionen. Colo Proctol (deutsche Ausgabe) 1987;9:153–156.

    Google Scholar 

  13. Jatzko G, Müller M, Lisborg P, Wette V, Klimpfinger M: Die Doppel-Klammernaht-Anastomose bei tiefer anteriorer Rektumresektion. Chirurg 1991;62:604–607.

    CAS  PubMed  Google Scholar 

  14. Jatzko G, Wette V, Müller M, Lisborg P, Klimpfinger M, Denk H: Simultaneous resection of colorectal cancer and synchronous liver metastases in a District Hospital. Int J Colorect Dis 1991;6:111–114.

    Article  CAS  Google Scholar 

  15. Jatzko G, Schlapper D: Die Tamponade der sacralen Wundhöhle nach Rektumamputation als sichere Alternative zum Drainage-Verfahren. Chirurg 1988;59:855–857.

    CAS  PubMed  Google Scholar 

  16. Jeekel J, Wiggers T: Can radical surgery improve survival in colorectal cancer? World J Surg 1987;11:412.

    Article  CAS  PubMed  Google Scholar 

  17. Jones PF, Thomson HJ: Long term results of a constant policy of sphincter preservation in the treatment of carcinoma of the rectum. Br J Surg 1982;69:564–568.

    Article  CAS  PubMed  Google Scholar 

  18. Klimpfinger M, Behan A, Denk H: Der pathologische Befund bei kolorektalen Karzinomen und Diskussion seiner Bedeutung für die stadiengerechte Tumortherapie. Wien klin Wschr 1987;14:488–493.

    Google Scholar 

  19. Krook J, Moertel C, et al: Radiation versus sequential chemotherapy radiation-chemotherapy, a study of the North Central Cancer Treatment Group, Duke University. Majo Clin Proc ASCO 1987;6:92.

    Google Scholar 

  20. Long RTL, Edwards RH: Implantation metastasis as cause of local recurrence ofcolorectal carcinoma. Am J Surg 1989;127:194–201.

    Article  Google Scholar 

  21. Mason A: Malignant tumors of the rectum: local excision. Clin Gastroenterol 1975;4:582–593.

    CAS  PubMed  Google Scholar 

  22. McDermott FT, Hughes ESR, Phil E, Johnson WR, Price AB: Local recurrence after potentially curative resections for rectal cancer in a series of 1008 patients. Br J Surg 1985;72:34–37.

    Article  CAS  PubMed  Google Scholar 

  23. NIH Consensus Conference an Adjuvant Therapy for Patients with Colon and Rectal Cancer. JAMA 1990;264:1444–1450.

    Article  Google Scholar 

  24. Pilipshen STJ, Heilwerl M, Quan SH, Sternberg S, Enker WE: Patterns of pelvic recurrence, following definitive resections of rectal cancer. Cancer 1984;53:1354–1362.

    Article  CAS  PubMed  Google Scholar 

  25. Pollet WG, Nicolls RJ: The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma in the rectum. Ann Surg 1983;70:159–163.

    Article  Google Scholar 

  26. Quirke P, Durdey P, Dixon MF, Williams NS: Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Lancet 1986;II:996–999.

    Article  Google Scholar 

  27. Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G: Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983;52:1317–1329.

    Article  CAS  PubMed  Google Scholar 

  28. Tagert REB: Restorative rectal resection: an analysis of 222 cases. Br J Surg 1986;73:70–71.

    Article  Google Scholar 

  29. Vernara AM, Moran M, Rothenberger DA, Wong W: A prospective evaluation of distal margins in rectal cancer. Presented ASCRS, Anaheim/CA, 1988.

  30. Watanabe H, Joss JR, Sobbin LH: Histological Typing of Esophageal and Gastric Tumors. WHO-International Histological Classification of Tumors. 2nd ed. Berlin-Heidelberg-New York-London-Paris-Tokyo, Springer, 1990.

    Book  Google Scholar 

  31. Westhues H: Die pathologisch-anatomischen Grundlagen der Chirurgie des Rektumkarzinoms. Leipzig, Thieme, 1934.

    Google Scholar 

  32. Williams NS, Dixon MF, Johnson D: Re-appraisal of the 5 cm rule distal excision of carcinomas of the rectum: a study of distal intramural spread and of patients survival. Br J Surg 1983;70:150–154.

    Article  CAS  PubMed  Google Scholar 

  33. Williams NS: The rationale for preservation of the anal sphincter in patients with low rectal cancer. Br J Surg 1984;71:575–581.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Krankenhaus der Barmherzigen Brüder, Spitalgasse 26, A-9300, St. Veit/Glan, Austria

    G. Jatzko M.D., P. Lisborg, V. Wette & M. Horn

  2. Institute of Pathological Anatomy, University of Graz, Austria

    M. Klimpfinger

Authors
  1. G. Jatzko M.D.
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  2. P. Lisborg
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  3. V. Wette
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  4. M. Horn
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  5. M. Klimpfinger
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Jatzko, G., Lisborg, P., Wette, V. et al. Sphincter preservation — A fascinating challenge in rectal carcinoma surgery. Acta Chir Austriaca 26, 140–143 (1994). https://doi.org/10.1007/BF02620015

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  • DOI: https://doi.org/10.1007/BF02620015

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