outcome of sphincter-saving resection and abdomino-perineal resection for distal rectal cancer

ABSTRACT

The advent of surgical techniques has enabled more patients with mid and low rectal cancer to have sphincter saving resections [SSR]. This procedure, however has provoked doubts regarding the adequacy of resection and fear of increased rates of recurrence compared with Abdomino-perineal resection [APR]. The introduction of Total Mesorectal Excision [TME] has much lowered the recurrence rate to nearly 4%. This study was performed to compare the oncological results of SSR for low and mid rectal cancer patients with those obtained APR before that period. A total of one hundred and fifteen patients [115] were enrolled in this study. The tumours were located between 3-12cm from anal verge. Fifty one patients [45%] underwent SSR between the years 2002-2007. The incidence of recurrence after radical SSR was compared with the historical control group of sixty patients [52%] which underwent APR. The two groups being matched for Duke's stage and tumour location. Four patients had local treatment. The mean follow-up period of patients was 2.3 years, range [1-5] years. After 2 years follow-up, the local recurrence cumulative rate was 10.3% after SSR and 16.5% after APR. Distant recurrence rates were 15% and 20% respectively. Six patients [12%] died of their disease within 2 years of radical SSR, nine patients [15%] after radical APR. The overall 5 years actuarial survival in the SSR group was 70.2% compared to 64% in the retrospective matched control group who underwent APR. SSR for mid and low rectal tumours appears to have a superior outcome over APR since there is no risk of increased recurrent disease compared to APR after an equivalent follow-up period