Impact of total mesorectal excision on the results of surgery of distal rectal cancer.

Abstract

This study reviewed the results of surgery for distal rectal cancer (tumours within 6 cm of the anal verge) following the introduction of total mesorectal excision for rectal cancer in one institution. Two hundred and five patients who had undergone surgical resection of rectal cancer within 6 cm of the anal verge were included. The demographic, operative and follow-up data were collected prospectively. Comparisons were made between patients who had different surgical procedures. Abdominoperineal resection (APR) was performed in 27.8 per cent of patients, falling from 36.0 per cent in the first 3 years to 20.0 per cent in the last 3 years of the study. The overall operative mortality rate was 1.5 per cent and the morbidity rate 30.2 per cent. With a mean follow-up of 36 months, local recurrence occurred in 28 of the 185 patients who had curative resection. The 5-year actuarial local recurrence rates for double-stapled anastomosis, peranal coloanal anastomosis and APR were 11.2, 34.6 and 23.5 per cent respectively. The local recurrence rate was significantly lower for double-stapled low anterior resection than for the other types of operation. The overall 5-year survival rate in patients with low anterior resection and APR was 69.1 and 51.1 per cent respectively (P = 0.12). With the practice of total mesorectal excision, APR was necessary in only 27.8 per cent of patients with rectal cancer within 6 cm of the anal verge. The local recurrence rate was much lower in patients with double-stapled low anterior resection than in those treated with APR or peranal anastomosis.