ONCOLOGICAL AND FUNCTIONAL RESULTS OF DIR ECT COLOANAL ANASTOMOSIS AFTER TOTAL RESECTION OF THE RECTUM FOR CANCER

From january 1986 to december 1992, 71 patients underwent direct colo- anal anastomosis as described by Parks (CAA) after total rectal resect ion for carcinoma : 49 men and 22 women with a mean age of 64 years (r ange 37-82). In 67 cases, the indication was for adenocarcinoma of the mid and low rectum, and in 4 cases for carcinoma of the upper rectum associated with a low rectal benign tumour (6 Dukes A, 36 Dukes B, 21 Dukes C, 8 Dukes D). A diverting colostomy was constructed in all case s. One patient died from pulmonary embolism (mortality : 1.4 %). Anast omotic leakage occurred in 6 cases (8.5 %). None of these cases requir ed reoperation and all colostomies have been closed. Local recurrence occurred in 12 cases (17 %) 6 to 34 months after CAA, of whom 4 were t reated by abdominoperineal resection. Eleven patients died from local recurrence (3 cases) or distant metastasis (8 cases). Actuarial surviv al at 1, 2, 3, 4 and 5 years was 92 %, 88 %, 78 %, 75 % and 69 % respe ctively. From the functional point of view, one patient underwent abdo mino-perineal resection for incontinence 3 years after CAA. All the ot her patients were fully continent, with a mean stool frequency of 2 pe r day, and good gas-stool discrimination. Twenty per cent of patients presented soiling, 20 % with stool frequency, and 12 % with urgency. L ong term functional and oncological results make CAA a good alternativ e to abdomino-perineal resection for mid and low rectal carcinoma.