LOW RECTAL-CANCER - WHAT IS THE CHOICE

In patients operated on for low rectal cancer, the functional results, disease recurrence, and survival have been evaluated with respect to the type of surgery performed. Particular attention was paid to analys is of the pathologic aspects, considered in our opinion, as risk facto rs for recurrence. The investigation was carried out on 131 patients, of whom 70 received anterior resection, 55 abdominoperineal resection, and 6 local treatment. Abdominoperineal resection was carried out in more advanced disease. Postoperative mortality was 2.1 percent after a nterior resection and 0 after abdominoperineal resection or local trea tment. Follow-up, carried out in 96 patients (44 anterior resections, 46 abdominoperineal resections, and 6 local treatments), ranged from 1 2 to 84 (mean, 33.3) months. Recurrence rate was 53.3 percent after ab dominoperineal resection and 28.9 percent after anterior resection. Re currence appears not be related to the treatment performed, but rather depend on certain aspects of the neoplasm such as diameter exceeding 5 cm, extraparietal infiltration, lymphangitis, and tumor indifferenti ation. We observed anastomotic recurrence in 28.6 percent of patients with a margin of less than 2 cm. An intensive follow-up scheme enabled us to recognize this type of recurrence early and to reoperate with r adical intent. One year after anterior resection functional results we re encouraging. No severe incontinence was reported. Local treatment w as performed in carefully selected patients (T1, N0) and no cases of m ortality or recurrence were observed.