EXTRAFASCIAL EXCISION OF THE RECTUM FOR RECTAL-CANCER

Background The fascia propria of the rectum is an upward capsular proj ection from the superior fascia of the pelvic floor which surrounds th e rectum and its mesorectum posteriorly and the fat, blood vessels, ne rves and lymphatics in front and laterally. It is postulated that if r ectal cancer is contained within the fascia propria and extrafascial e xcision of the rectum is performed then it would be exceptional for th e cancer to recur locally. Methods A total of 122 consecutive patients with rectal cancer underwent extrafascial excision of the rectum. The operation involved mobilizing the rectum outside its fascia propria a nd removing not only the rectum and its mesorectum posteriorly but als o the fat, blood vessels, nerves and lymphatics in front and laterally . Resection was considered curative unless there were distant metastas es or the tumour had involved the resection margins. Results There was one postoperative death. The cumulative cancer-free survival rate at 5 years was 68 per cent. In 100 patients in whom the operation was con sidered to be curative, the cumulative cancer-free survival rate was 8 1 per cent. Eighty-four of these patients were available for a minimum follow-up of 24 (median 73, range 24-193) months. Three (4 per cent) developed local recurrence. In two patients this was at the anastomosi s. Conclusion If the cancer is contained within the fascial tube surro unding the rectum and complete extrafascial excision has been performe d, local recurrence will be minimal.