[ colon-anal anastomosis with temporary protective colostomy for lower rectal tumors following preoperative radiotherapy]

ABSTRACT

The aim of this study was to evaluate the local experience in preserving the anal sphincter in patients with low rectal tumors using manual colo-anal anstomosis, protected with a temporary colostomy, after a preoperative course of radiotherapy. Fourty-two [42] patients were followed up in our teaching hospitals included in this study, during the period between 1999 and 2002. Their tumors was lower than 15 cm from anal sphincter [<15cm] on the rigid sigmoidoscope, these patients were divided into three groups the first group 7 patients in whom the lower edge of the tumor was 5 cm from the anus, they were given preoperative course of radiotherapy. The second group 15 patients, in whom the tumor was 5-7 cm from the anus, they were also given a course of preoperative radiotherapy. The third group 20 patients, their tumor was higher than 8 cm from the anus, they had immediate surgical treatment without radiotherapy prior to surgery. The interim period between surgery and radiotherapy was 30 days, and patients were given 40 gray during three weeks. Patients were followed-up for [8-48] months, there was no deaths, no fistula and no perineal infection during the convalescence period, there was left colon necrosis in one case, and early stenosis in the anastomosis in another. Local recurrence was evident in five patients; it was controlled in one case by abdomino-perineal resection. The functional results, were good in 66.6% after two years of follow-up. The patients had an average of three stools per day after one year, the average of total survival rate for four years was 83.3%. It is possible to preserve the anal sphincter with low colo-anal anastomosis for the treatment of tumors of the lower third of the rectum with the help of a preoperative radiotherapy, with good results on the functional and canerous levels, as an alternative treatment to abdomino-perineal resection in selected patient