TOTAL RECTAL RESECTION, MESORECTUM EXCISION, AND COLOENDOANAL ANASTOMOSIS - A THERAPEUTIC OPTION FOR THE TREATMENT OF LOW RECTAL-CANCER

Background: There is recent and sporadic evidence indicating that pati ents with very low rectal cancer may be treated via a sphincter-saving procedure, obviating the need for abdominoperineal resection and defi nitive colostomy. This study confirms these findings. Methods: From Ma rch 1990 to October 1994, 79 patients affected with primary low rectal cancers were submitted for total rectal resection, mesorectum excisio n, and coloendoanal anastomosis. All lesions were located within 8 cm of the anal verge (within 6 cm in 64 cases). Results: Eight patients r elapsed at the pelvic level, and one patient only at the paraanastomot ic site. Postoperative morbidity attributable to the procedure was low . A perfect continence was documented in 66% of cases after colostomy closure, and many patients (63%) had one or two bowel movements a day. Sixty-two patients of this series are alive, 49 without actual eviden ce of disease. Follow-up ranged from 2 to 56 months (median 23). Concl usions: The clinical and pathological data derived from this study sug gest that radical mesorectum excision more than a large clearance marg in of resection remains the most important factor in reducing the inci dence of local relapse after low rectal cancer surgery and that total rectal resection and coloendoanal anastomosis is a suitable and safe o ption to traditional, demolitive surgical techniques.