OUTCOME OF RESTORATIVE PERINEAL GRACILOPLASTY WITH SIMULTANEOUS EXCISION OF THE ANUS AND RECTUM FOR CANCER - A 10-YEAR EXPERIENCE WITH 81 PATIENTS

PURPOSE: To review the complications, survival, and longterm functiona l outcome of patients with anorectal cancer who had restorative perine al graciloplasty (RPG) simultaneously with abdominoperineal resection (APR). METHODS: Between 1985 and 1994, 81 patients underwent APR plus RPG. Gracilis muscles were then conditioned by electrostimulation, eit her intermittently or chronically. Thirty-seven surviving patients wer e followed for a mean of 78.6 months and were analyzed for long-term f unctional outcome of RPG. RESULTS: Postoperative complications occurre d in 30 patients (37 percent). Crude five-year survival rate was 58 pe rcent, and five-year estimated cumulative probability of survival was 65 percent. There was no statistically significant difference for prob ability of survival and for probability of disease-free interval betwe en uncomplicated and complicated patients. Fecal continence was obtain ed in 90 percent of patients. CONCLUSION: RPG does not reduce the effe ctiveness of APR in the cure of cancer. Postoperative complications, t hough frequent, were not serious and resolved without sequelae. There was no statistically significant impact on the probability of survival and of disease-free interval by graciloplasty. Continence was achieve d by most patients (90 percent) who underwent RPG simultaneously with APR.