RESUMEN
Objectives: This study was designed to evaluate oncological results of abdominoperineal resection (APR) after introduction oftotal mesorectal excision. The final end-points were local recurrence and survival curves. The results were compared withanterior resection (AR). Methods: Seventy-one patients (54 percent males; median age, 59.5 range, 29-82 years) withrectal cancer were submitted to surgery with curative intention from May 1999 to December 2004 at the Division of Coloproctologyand Small Bowel of Alfa Institute of Gastroenterology at Federal University of Minas Gerais Hospital. Operative procedureswere classified as either abdominoperineal resections or anterior resections with coloanal or low rectal anastomosis. Totalmesorectal excision was routinely performed for carcinomas of the lower middle and lower third of the rectum. Data weretracked prospectively. Local recurrences and cancer-related survival rates were estimated. Results: Twenty patients had tumorlocated in the lower third of rectum (28 per cent) and 11 of them (55 per cent) were submitted to APR. Overall, 15.5 percentof patients with rectal tumor were treated by APR. Estimated rates of local recurrence were 6 percent for AR patients and 23percent for APR patients (p = 0.0778). Estimated rates for cancer related survival in patients submitted to APR was 67 percentand for AR patients was 78 percent (p = 0.2910). Conclusion: There is an important trend to poor oncological results of APRwhen compared with AR in patients with rectal cancer submitted to total mesorectal excision. This clinical observation elicitsthe necessity of a different approach for low rectal tumors, probably using a more radical APR and routine preoperativeradiotherapy.