Abstract
The aim of this retrospective study is to compare the outcome of abdominoperineal excision (APE) and anterior resection (AR) for rectal cancer in terms of local tumor recurrence. A further comparison has been carried out between hand-sewn and stapled anastomosis; 147 patients have been followed for at least 2 years: 69 after APE and 78 after AR, 40 being stapled. The following variables potentially related to the risk of recurrence were evaluated: age, grading, staging, and site of the tumor. An overall 2-year local recurrence rate of 11 percent after APE and 12 percent after AR was observed, whereas it was 13 and 11 percent following stapled and hand-sewn sutures, respectively. Both differences were not statistically significant. A similar local recurrence rate was noted after APE and AR when the patients were matched for Dukes' stage and grading of the lesion. A trend toward an increased risk of recurrence following AR (P=0.07) was shown when comparing the two procedures if mid and upper rectal cancers were grouped together. In the patients with anastomotic leaks after AR, no increase of local recurrence was observed. In conclusion, AR is unlikely to be followed by an increased risk of local recurrence and, therefore, when oncologically indicated, may be considered the operation of choice in the treatment of rectal cancer, although the possible risk of its overuse should be taken into account.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Pheils MT, Chapuis PH, Newland RC, Colquhoun K. Local recurrence following curative resection for carcinoma of the rectum. Dis Colon Rectum 1983;26:98–102.
Williams N, Johnston D. Survival and recurrence after sphincter saving resection and abdominoperineal resection for carcinoma of the of the middle third of the rectum. Br J Surg 1984;71:278–82.
Phillips RK, Hittinger R, Blesovski 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.
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery: the clue to pelvis recurrence? Br J Surg 1982;69:613–6.
Heimann TM, Szporn A, Bolnick K, Aufses AH Jr. Local recurrence following surgical treatment of rectal cancer: comparison of anterior and abdominoperineal resection. Dis Colon Rectum 1986;29:862–4.
Hurst PA, Prout WG, Kelly JM, Bannister JJ, Walter RT. Local recurrence after low anterior resection using the staple gun. Br J Surg 1982;69:275–6.
Leff EI, Shaver JO, Hoexter B,et al. Anastomotic recurrence after low anterior resection: stapledvs. hand-sewn. Dis Colon Rectum 1985;28:164–7.
Lasson AAL, Ekelund GR, Lindstroem CG. Recurrence risk after stapled anastomosis for rectal carcinoma. Acta Chir Scand 1984;100:85–9.
Sauven P, Playforth MJ, Evans M, Pollock AV. Early infective complications and late recurrent cancer in stapled colonic anastomoses. Dis Colon Rectum 1989;32:33–5.
Colton T. Statistics in medicine. Boston: Little Brown, 1974.
Pescatori M, Maria G, Mattana C, Ferrara A, Lucibello L. Outcome of colorectal cancer. Br J Surg 1987;74:370–2.
Rosen CB, Beart RW Jr, Ilstrup DM. Local recurrence of rectal carcinoma after hand-sewn and stapled anastomoses. Dis Colon Rectum 1985;28:305–9.
Gillen P, Peel AL. Comparison of the mortality, morbidity, and incidence of local recurrence in patients with rectal cancer treated by either stapled anterior resection or abdominoperineal resection. Br J Surg 1986;73:339–41.
Williams NS, Durdey P, Johnston D. The outcome following sphincter-saving resection and abdominoperineal resection for low rectal cancer. Br J Surg 1985;72:595–8.
Tagart RE. Restorative rectal resection: an audit of 220 cases. Br J Surg 1986;73:70–1.
Zannini G, Renda A, Lepore R, Coppola L, Landi R, D'Antonio M. Mechanical anterior resection for carcinoma of the midrectum: long term results. Int Surg 1987;72:18–9.
Belli L, Beati CA, Frangi M, Aseni P, Rondinara GF. Outcome of patients with rectal cancer treated by stapled anterior resection. Br J Surg 1988;75:422–4.
Reid JD, Robins RE, Atkinson KG. Pelvic recurrence after anterior resection and EEA stapling anastomosis for potentially curable carcinoma of the rectum. Am J Surg 1984;147:629–32.
Anderberg B, Enblad P, Sjodhal R, Wetterfors J. Recurrent rectal carcinoma after anterior resection and rectal stapling. Br J Surg 1984;71:98–100.
Devereux DF, Deckers PJ. Contribution of pathologic margins and Dukes' stage to local recurrence in colorectal carcinoma. Am J Surg 1985;149:323–5.
Heald RJ. The Holy Plane of rectal surgery. J R Soc Med 1988;81:503–8.
Cawthorn SJ, Parums DV, Gibbs NM, Marks CG. The correlation between the precise measurement of mesorectal spread and survival after surgery for rectal cancer. (unpublished observations).
Author information
Authors and Affiliations
About this article
Cite this article
Amato, A., Pescatori, M. & Butti, A. Local recurrence following abdominoperineal excision and anterior resection for rectal carcinoma. Dis Colon Rectum 34, 317–322 (1991). https://doi.org/10.1007/BF02050591
Issue Date:
DOI: https://doi.org/10.1007/BF02050591