Oncologic Results according to Operative Method after a Curative Resection for Low Rectal Cancers

ABSTRACT

PURPOSE: Although the current trend is to use a sphincter- saving operation (SSO) for management of distal rectal cancer, an abdominoperineal resection (APR) is widely performed in low rectal cancers. Numerous studies have reported that lateral margin is an important prognostic factor for recurrence in low rectal cancers. In regard to curability, the presence of an involved lateral margin after a resection of a low rectal cancer is currently accepted as being an indicator of a non-curative resection. Indeed, the higher rate of positive lateral margins after APRs than after a SSO may explain the inferior oncologic outcomes of APRs. Therefore, the purpose of this study was to analyse the oncologic results of 'curative' APRs and SSOs. METHODS: This retrospective study included 111 patients who had undergone surgical treatment between 1995 and 2000 with either an APR (n=65) or a SSO (n=46). The oncological outcomes of the patients who had undergone an APR were compared with those of the patients who had undergone a SSO. Univariate and multivariate analyses were used to evaluate the data. RESULTS: The distal resection margin and the mean distance between the tumor low margin and the dentate line were significantly different between the two groups. However, the disease-free and the overall survivals, as well as the frequency of local recurrence and that of overall recurrence, after rectal excision did not differ between the two groups. Multivariate analyses showed that the method of surgery was not a significant independent factor in predicting either disease-free survival or overall survival. However, advanced stage III was a significant predictor of outcome after the operation. CONCLUSIONS: The type of operation did not affect the oncological outcome after a 'curative' resection for distal rectal cancer.