Total rectal resection and complete mesorectum excision followed by coloendoanal anastomosis as the optimal treatment for low rectal cancer: The experience of the National Cancer Institute of Milano

Background: At present, abdominoperineal resection remains the most diffuse method of treatment of very low rectal cancer. Today, we can avoid this me thod in some patients by using a sphincter-saving procedure. Methods: From March 1990 to January 1999, 273 consecutive total rectal rese ctions and coloendoanal anastomoses were performed at our Institute; this s tudy concerns 141 consecutive patients treated for a primary adenocarcinoma of the distal rectum, from 3.5 to 8 cm from the anal verge. Patient strati fication, based on definitive pathological report, was 31 Dukes' stage A (T 2N0), 44 stage B (T3N0), and 66 stage C (T2N+-T3N+). Results: Overall recurrence rate was 9.2%; postoperative morbidity attribut able to the procedure was low. A perfect continence was documented in 61% o f cases. The only pathological factor related to local recurrence rate is p eritumoral lymphocytic reaction inside and around the tumor (P = .0005 and .031) independently from the number of metastatic lymph nodes, depth of fat ty tissue infiltration, and lymphatic and venous neoplastic emboli. The min imum follow-up time is 12 months. Conclusions: Our data, in accordance with other authors, seem to highlight the relevant role that a well-practiced surgery, together with accurate inf ormation on the spreading of this disease, has in achieving an optimal loca l control of cancer.