OUTCOME AFTER CURATIVE SURGERY FOR CARCINOMA OF THE LOWER 1 3 OF THE RECTUM/

Background Controversy exists about the optimal surgical resection for lower third rectal carcinoma. The aim of this retrospective study was to analyse whether the type of surgery is a significant predictor of outcome after curative surgery alone. Methods Eighty-two consecutive p atients underwent abdominoperineal rectum excision (APRE, 41 patients) or sphincter-saving operation (SSO, 41 patients) for adenocarcinoma a t 3.5-7.5 cm from the anal margin. Cox proportional hazards technique with univariate and corrected (multivariate) analyses and the Kaplan-M eier life-table method were used to evaluate the data. Results Tumour wall penetration and lymph node involvement, but not the tumour level or the type of surgery, were found to be significant predictors of out come. The local recurrence rate at 1, 2 and 5 years was 10, 22 and 26 per cent respectively after APRE, and 5, 13 and 21 per cent after SSO. The disease-free survival rate at 1. 2 and 5 years was 85, 67 and 58 per cent respectively after APRE, and 88, 78 and 62 per cent after SSO . Conclusion Tumour-related factors are significant predictors of outc ome. The type of surgery (APRE or SSO) did not seem to be a significan t variable in this non-randomized study.