LONG-TERM RESULTS OF ANTERIOR RESECTION USING THE DOUBLE-STAPLING TECHNIQUE

PURPOSE: This study was designed to determine the anastomotic leak rat e, local recurrence rate, and survival of patients undergoing anterior resection with the double-stapling technique for rectal cancer. METHO DS: Between 1981 and 1992, 189 patients underwent a curative (166) or palliative (23) anterior resection using the double-stapling technique . A chart review was performed, and follow-up information was obtained from the patient or family physician. Follow-up was complete in 186 p atients (98 percent). RESULTS: There were five (2.6 percent) stapler-r elated complications, of which two patients required a defunctioning c olostomy. Postoperative mortality was 1.6 percent, and clinical leak r ate was 7.3 percent. Clinical leak rate was significantly higher in pa tients with lesions in the lower third (20 percent) compared with thos e in the middle and upper thirds (9 and 1 percent, respectively; P < 0 .05). After a mean follow-up of 32 +/- 29 months, local recurrence rat e was 9.1 percent but was significantly higher in patients more than 6 5 years old (14 vs. 1 percent; P < 0.005) and in patients with resecti on margins less than 2.0 cm (17 vs. 5.5 percent; P < 0.05). Five-year survival was 78 percent. CONCLUSIONS: Anterior resection performed wit h the double-stapling technique has an acceptable clinical leak rate, local recurrence rate, and survival rate. However, the clinical leak r ate appears to be increased in patients with low tumors and, therefore , a defunctioning colostomy should be considered. Resection margins of more than 2 cm are necessary.